Journal of Clinical Medicine (Nov 2023)

A Meta-Analysis of Short-Term Outcomes of TAVR versus SAVR in Bicuspid Aortic Valve Stenosis and TAVR Results in Different Bicuspid Valve Anatomies

  • Riccardo Improta,
  • Gianluca Di Pietro,
  • Novis Kola,
  • Lucia Ilaria Birtolo,
  • Riccardo Colantonio,
  • Emanuele Bruno,
  • Marco Tocci,
  • Alessandra Giansante,
  • Michele Sannino,
  • Veronica Zullino,
  • Sara Monosilio,
  • Sara Cimino,
  • Viviana Maestrini,
  • Paolo Severino,
  • Roberto Badagliacca,
  • Carlo Lavalle,
  • Paola Celli,
  • Wael Saade,
  • Carmine Musto,
  • Fabrizio D’Ascenzo,
  • Fabio Miraldi,
  • Carmine Dario Vizza,
  • Gennaro Sardella,
  • Massimo Mancone

DOI
https://doi.org/10.3390/jcm12237371
Journal volume & issue
Vol. 12, no. 23
p. 7371

Abstract

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Background: To provide a comprehensive analysis of the current literature comparing the outcomes of surgical aortic valve replacement (SAVR) and transcatheter aortic valve replacement (TAVR) in patients with bicuspid aortic stenosis (BAS), with particular attention to BAV morphology in patients undergoing TAVR. Methods: Following PRISMA guidelines, all relevant articles with no design restrictions from PubMed, CCTR (Cochrane Controlled Trials Register), and Google Scholar were screened for inclusion. Studies were included if they reported clinical endpoints for SAVR and TAVR or, in BAS treated with TAVR, for type 1 and non-type 1 morphology. Odds ratio and Cohen’s D were considered as effect size measurements for qualitative and quantitative variables, respectively. Results: A total of eight studies comparing short-term outcomes between SAVR and TAVR and nine studies with outcomes data between type 1 and non-type 1 BAS treated with TAVR were considered for the final analysis. No statistically significant difference was found for what concerns the rates of death, stroke, and acute kidney injury between SAVR and TAVR. In comparison to patients undergoing SAVR, the incidence of PPI (permanent pacemaker implantation) was greater in the TAVR group (OR 0.35, 95% CI 0.15–0.79, p = 0.01), and the frequency of bleeding events was found to be higher among patients undergoing SAVR (OR 4.3, 95% CI 2.9–6.4, p p <0.001). Mildly lower post-procedural transprothesic gradients were found in patients with type 1 morphology. Conclusions: In BAS patients, TAVR has comparable short-term outcomes rates with SAVR, but higher PPI rates and lower incidence of bleeding events. In patients undergoing TAVR, type 1 BAS is associated with lower postoperative transvalvular gradients but higher PPI rates and conduction abnormalities

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