Mortality No Different With TAVR for Bicuspid, Tricuspid Stenosis

For patients undergoing transcatheter aortic valve replacement (TAVR) for aortic stenosis, there is no significant difference in 30-day or one-year mortality for bicuspid or tricuspid aortic stenosis, according to a study published in the Journal of the American Medical Association.

Raj R. Makkar, M.D., from the Smidt Heart Institute at the Cedars-Sinai Medical Center in Los Angeles, and colleagues compared outcomes of TAVR with a balloon-expandable valve for bicuspid versus tricuspid aortic stenosis. Data were included for 2,691 propensity score-matched pairs of patients with bicuspid and tricuspid aortic stenosis.

The researchers observed no significant difference in all-cause mortality for patients with bicuspid and tricuspid aortic stenosis at 30 days (2.6 versus 2.5 percent; hazard ratio, 1.04; 95 percent confidence interval, 0.74 to 1.47) and one year (10.5 versus 12.0 percent; hazard ratio, 0.90; 95 percent confidence interval, 0.73 to 1.10). For bicuspid versus tricuspid aortic stenosis, the 30-day stroke rate was significantly higher (2.5 versus 1.6 percent; hazard ratio, 1.57; 95 percent confidence interval, 1.06 to 2.33). In the bicuspid versus the tricuspid group, the risk for procedural complications requiring open heart surgery was significantly higher (0.9 versus 0.4 percent; absolute risk difference, 0.5 percent; 95 percent confidence interval, 0 to 0.9 percent).

"Until data from randomized clinical trials are available, these registry data may be able to guide clinical practice," the authors write. "Even though not randomized, these represent generalized outcomes not restricted to highest-volume or most experienced TAVR centers."

Several authors disclosed financial ties to the pharmaceutical and medical device industries.

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