Surgical Versus Transcatheter Aortic Valve Replacement in Bicuspid Aortic Stenosis: 1‐Year Clinical Outcomes in Patients Aged 65 Years and Older

Background Transcatheter aortic valve replacement (TAVR) has shown noninferiority to surgical aortic valve replacement (SAVR). However, patients with bicuspid aortic stenosis are often excluded from these studies. More insights between these procedures in this population is crucial for treatment selection. Methods In this multicenter observational study, patients with bicuspid aortic stenosis undergoing TAVR or SAVR were analyzed using propensity score matching. The primary outcome was a composite of all‐cause mortality, stroke, rehospitalization, or valve dysfunction at 1 year. Results A total of 997 patients with bicuspid aortic stenosis underwent TAVR or SAVR. In the matched cohort of 256 pairs, the median age was 75.0 years (interquartile range, 71.0–78.0), 234 (44.9%) were women, and the median EuroScore II was 1.83% (interquartile range, 1.34–2.86). One‐year cumulative incidence of the primary outcome was 15.0% in TAVR compared with 12.0% in SAVR (hazard ratio [HR], 1.35 [95% CI, 0.83–2.19], P =0.23). Mortality (4.3% versus 5.0%, P =0.72) and rehospitalization (4.8% versus 6.4%, P =0.45) were similar between groups. Although rates of valve dysfunction (2.9% versus 0.5%, P =0.06) and stroke (5.3% versus 2.3%, P =0.10) were numerically lower in the surgical group at 1 year, both the risk of stroke (subdistribution HR, 3.01, P =0.02) and valve dysfunction (subdistribution HR, 4.16, P =0.03) were significantly higher in the TAVR group at 2 years. Conclusions TAVR in patients with bicuspid aortic stenosis showed a similar 1‐year primary outcome rate compared with SAVR, though TAVR exhibited higher rates of valve dysfunction and stroke. These findings underscore the need for randomized trials to define the optimal treatment strategy for this population.

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Journal
Journal of the American Heart Association
Published
2026-05-14
DOI
https://doi.org/10.1161/jaha.125.045763
Primary Topic
Cardiac Valve Diseases and Treatments
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article
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article

Surgical Versus Transcatheter Aortic Valve Replacement in Bicuspid Aortic Stenosis: 1‐Year Clinical Outcomes in Patients Aged 65 Years and Older

Toon Winkelman, Alicia Prieto-Lobato, Nieves Gonzalo, Adrián Margarida et al.
Journal of the American Heart Association
Cardiac Valve Diseases and Treatments
article

Surgical Versus Transcatheter Aortic Valve Replacement in Bicuspid Aortic Stenosis: 1‐Year Clinical Outcomes in Patients Aged 65 Years and Older

Toon Winkelman, Alicia Prieto-Lobato, Nieves Gonzalo, Adrián Margarida, Jesús Jiménez‐Mazuecos, Kimberley Hemelrijk, Elena Roselló-Díez, Juan Bustamante Munguira, Carlos Arellano Serrano, Gabriela Tirado-Conte, Thibaut Guitteny, Daniel Pérez-Camargo, Antonio Muñoz-García, I Amat Santos, Y Kobari, Diego López Otero, Lluís Asmarats, Javier Gomez‐Herrero, Luis Nombela‐Franco, Ole De Backer, Darren Mylotte, Pilar Jimenez‐Quevedo, Dabit Arzamendi, Angela McInerney, Ronak Delewi, Francisco Campelo‐Parada, Manuel Carnero, Gabriela Veiga, Juan Francisco Oteo Domínguez, Alex Castro‐Mejía, Sandra Casellas‐Casanovas, Jose M de la Torre Hernandez, Matias R Mon Noboa
article en

Abstract

Background Transcatheter aortic valve replacement (TAVR) has shown noninferiority to surgical aortic valve replacement (SAVR). However, patients with bicuspid aortic stenosis are often excluded from these studies. More insights between these procedures in this population is crucial for treatment selection. Methods In this multicenter observational study, patients with bicuspid aortic stenosis undergoing TAVR or SAVR were analyzed using propensity score matching. The primary outcome was a composite of all‐cause mortality, stroke, rehospitalization, or valve dysfunction at 1 year. Results A total of 997 patients with bicuspid aortic stenosis underwent TAVR or SAVR. In the matched cohort of 256 pairs, the median age was 75.0 years (interquartile range, 71.0–78.0), 234 (44.9%) were women, and the median EuroScore II was 1.83% (interquartile range, 1.34–2.86). One‐year cumulative incidence of the primary outcome was 15.0% in TAVR compared with 12.0% in SAVR (hazard ratio [HR], 1.35 [95% CI, 0.83–2.19], P =0.23). Mortality (4.3% versus 5.0%, P =0.72) and rehospitalization (4.8% versus 6.4%, P =0.45) were similar between groups. Although rates of valve dysfunction (2.9% versus 0.5%, P =0.06) and stroke (5.3% versus 2.3%, P =0.10) were numerically lower in the surgical group at 1 year, both the risk of stroke (subdistribution HR, 3.01, P =0.02) and valve dysfunction (subdistribution HR, 4.16, P =0.03) were significantly higher in the TAVR group at 2 years. Conclusions TAVR in patients with bicuspid aortic stenosis showed a similar 1‐year primary outcome rate compared with SAVR, though TAVR exhibited higher rates of valve dysfunction and stroke. These findings underscore the need for randomized trials to define the optimal treatment strategy for this population.

Journal of the American Heart Association
Hospital de Sant Pau (ES), Copenhagen University Hospital (DK), Rigshospitalet (DK), Health Service Executive (IE), Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (ES), Hospital Universitario Puerta de Hierro Majadahonda (ES), Instituto de Investigación Marqués de Valdecilla (ES), Hôpital Rangueil (FR), Native Health (US), Complexo Hospitalario Universitario A Coruña (ES), Complejo Hospitalario Universitario de Albacete (ES), Hospital Clínico Universitario Virgen de la Victoria (ES), Hospital Clínico Universitario de Valladolid (ES), University of Amsterdam (NL)
Good health and well-being
Openalex Percentile: Top 5%
Cardiac Valve Diseases and Treatments
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