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Clinical Outcomes and the Impact of Valve Morphology for Transcatheter Aortic Valve Replacement in Bicuspid Aortic Valves: A Systematic Review and Meta-Analysis Publisher Pubmed



Gupta R1 ; Mahmoudi E2 ; Behnoush AH3 ; Malik AH4 ; Mahajan P5 ; Lin M6 ; Bandyopadhyay D4 ; Goel A4 ; Chakraborty S4 ; Aedma SK5 ; Gupta HB7 ; Vyas AV1 ; Combs WG1 ; Mathur M8 Show All Authors
Authors
  1. Gupta R1
  2. Mahmoudi E2
  3. Behnoush AH3
  4. Malik AH4
  5. Mahajan P5
  6. Lin M6
  7. Bandyopadhyay D4
  8. Goel A4
  9. Chakraborty S4
  10. Aedma SK5
  11. Gupta HB7
  12. Vyas AV1
  13. Combs WG1
  14. Mathur M8
  15. Yakubov SJ9
  16. Patel NC1
Show Affiliations
Authors Affiliations
  1. 1. Lehigh Valley Heart Institute, Lehigh Valley Health Network, Allentown, PA, United States
  2. 2. Universal Scientific Education and Research Network, Tehran University of Medical Sciences, Tehran, Iran
  3. 3. School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
  4. 4. Department of Cardiology, Westchester Medical Center and New York Medical College, Valhalla, NY, United States
  5. 5. Department of Medicine, Carle Foundation Hospital, Urbana, IL, United States
  6. 6. Morsani College of Medicine, University of South Florida, Tampa, FL, United States
  7. 7. Guru Nanak Dev Hospital, Department of medicine, Government Medical College, Punjab, Amritsar, India
  8. 8. Heart & Vascular Institute, Penn State Health, Milton S. Hershey Medical Center, Hershey, PA, United States
  9. 9. Department of Interventional Cardiology, Riverside Methodist-Ohio Health, Columbus, OH, United States

Source: Catheterization and Cardiovascular Interventions Published:2023


Abstract

Background: Bicuspid aortic valve (BAV) is present in approximately 0.5%–2% of the general population, causing significant aortic stenosis (AS) in 12%–37% of affected individuals. Transcatheter aortic valve replacement (TAVR) is being considered the treatment of choice in patients with symptomatic AS across all risk spectra. Aim: Aim Our study aims to compare TAVR outcomes in patients with BAV versus tricuspid aortic valves (TAV). Methods: A comprehensive literature search was performed in PubMed, Web of Science, and Cochrane trials. Studies were included if they included BAV and TAV patients undergoing TAVR with quantitative data available for at least one of our predefined outcomes. Meta-analysis was performed by the random-effects model using Stata software. Results: Fifty studies of 203,288 patients were included. BAV patients had increased 30-day all-cause mortality (odds ratio [OR] = 1.23 [1.00–1.50], p = 0.05), in-hospital stroke (OR = 1.39 [1.01–1.93], p = 0.05), in-hospital and 30-day PPI (OR = 1.13 [1.00–1.27], p = 0.04; OR = 1.16 [1.04–1.13], p = 0.01) and in-hospital, 30-day and 1-year aortic regurgitation (AR) (OR = 1.48 [1.19–1.83], p < 0.01; OR = 1.79 [1.26–2.52], p < 0.01; OR = 1.64 [1.03–2.60], p = 0.04). Subgroup analysis on new-generation valves showed a reduced 1-year all-cause mortality (OR = 0.86 [CI = 0.75–0.98], p = 0.03), despite higher in-hospital and 30-day PPI (OR = 0.1.21 [1.04–1.41], p = 0.01; OR = 1.17 [1.05–1.31], p = 0.01) and in-hospital AR (OR = 1.62 [1.14–2.31], p = 0.01) in the BAV group. The quality of included studies was moderate-to-high, and only three analyses presented high heterogeneity. Conclusion: TAVR is associated with comparable outcomes in patients with BAV and TAV. Careful selection of BAV cases by preprocedural assessment of valve anatomy and burden of calcification, pre- and post-procedural dilation, and implementing newer generations of valves may improve the safety and efficacy of TAVR in BAV patients. © 2023 Wiley Periodicals LLC.
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