University of Oulu

Husso, A., Airaksinen, J., Juvonen, T. et al. Transcatheter and surgical aortic valve replacement in patients with bicuspid aortic valve. Clin Res Cardiol 110, 429–439 (2021).

Transcatheter and surgical aortic valve replacement in patients with bicuspid aortic valve

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Author: Husso, Annastiina1; Airaksinen, Juhani2; Juvonen, Tatu3,4;
Organizations: 1Heart Center, Kuopio University Hospital, Kuopio, Finland
2Heart Center, Turku University Hospital, and University of Turku, Turku, Finland
3Heart and Lung Center, Helsinki University Hospital, Haartmaninkatu 4, P.O. Box 340, 00029, Helsinki, Finland
4Research Unit of Surgery, Anesthesiology and Critical Care, University of Oulu, Oulu, Finland
5Heart Hospital, Tampere University Hospital and Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
6Department of Internal Medicine, Oulu University Hospital, Oulu, Finland
Format: article
Version: published version
Access: open
Online Access: PDF Full Text (PDF, 1 MB)
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Language: English
Published: Springer Nature, 2021
Publish Date: 2021-04-21


Objectives: To compare the outcomes after surgical (SAVR) and transcatheter aortic valve replacement (TAVR) for severe stenosis of bicuspid aortic valve (BAV).

Methods: We evaluated the early and mid-term outcome of patients with stenotic BAV who underwent SAVR or TAVR for aortic stenosis from the nationwide FinnValve registry.

Results: The FinnValve registry included 6463 AS patients and 1023 (15.8%) of them had BAV. SAVR was performed in 920 patients and TAVR in 103 patients with BAV. In the overall series, device success after TAVR was comparable to SAVR (94.2% vs. 97.1%, p = 0.115). TAVR was associated with increased rate of mild-to-severe paravalvular regurgitation (PVR) (19.4% vs. 7.9%, p < 0.0001) and of moderate-to-severe PVR (2.9% vs. 0.7%, p = 0.053). When newer-generation TAVR devices were evaluated, mild-to-severe PVR (11.9% vs. 7.9%, p = 0.223) and moderate-to-severe PVR (0% vs. 0.7%, p = 1.000) were comparable to SAVR. Type 1 N-L and type 2 L-R/R-N were the BAV morphologies with higher incidence of mild-to-severe PVR (37.5% and 100%, adjusted for new-generation prostheses p = 0.025) compared to other types of BAVs. Among 75 propensity score-matched cohorts, 30-day mortality was 1.3% after TAVR and 5.3% after SAVR (p = 0.375), and 2-year mortality was 9.7% after TAVR and 18.7% after SAVR (p = 0.268).

Conclusions: In patients with stenotic BAV, TAVR seems to achieve early and mid-term results comparable to SAVR. Type 1 N-L and type 2 L-R/R-N BAV morphologies had higher incidence of PVR. Larger studies evaluating different phenotypes of BAV are needed to confirm these findings.

Clinical trial registration: Identifier: NCT03385915.

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Series: Clinical research in cardiology
ISSN: 1861-0684
ISSN-E: 1861-0692
ISSN-L: 1861-0684
Volume: 110
Issue: 3
Pages: 429 - 439
DOI: 10.1007/s00392-020-01761-3
Type of Publication: A1 Journal article – refereed
Field of Science: 3121 General medicine, internal medicine and other clinical medicine
Funding: Open access funding provided by University of Oulu including Oulu University Hospital.. This study was performed without external funding.
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