The anatomy of bicuspid valves varies; with some anatomies more suitable for TAVR than others. The heart team knows what type of anatomy has the best chance of working with TAVR. When they think it is treatable; it tends to be treatable. Patients with bicuspid valves including in this study had been selecting by the heart teams for the procedure so they probably had favorable anatomy.
TAVR works well for patients in their 70s and 80s, but we’re not sure what the best option is for younger patients those under about 60 may be better with surgery as we don’t have long-term data on TAVR, but that’s the same for tricuspid valve. We just see more younger patients with bicuspid disease.
Anatomy of bicuspid valves
TAVR on bicuspids; However, this new data is welcome as it supports what is already happening. And there will be clinicians who were cautious about TAVR on bicuspids but may be more comfortable now with this data. There were no significant differences in valve hemodynamics or in moderate or severe paravalvular leak between the two groups. Functional status and improvement in quality of life were also similar.
TAVR has become the established treatment for aortic stenosis in patients at increased surgical risk; and recent trials in patients at low surgical risk have also shown impressive results; with the transcatheter procedure now likely to become standard treatment for aortic stenosis patients of all risks.
Common tricuspid valves
However, all the randomized trials of TAVR to date have excluded patients with bicuspid valves; the anatomy of which is thought to be more difficult for the TAVR procedure to accommodate; than the more common tricuspid valves. The current study examined outcomes from consecutive patients at high or intermediate surgical risk undergoing TAVR; with the current-generation Sapien S3 valve recorded in the Transcatheter Valve Therapy Registry.
The stroke rate was higher in patients with bicuspid aortic stenosis at 30 days but did not significantly differ at 1 year between the 2 groups. There were no significant differences in valve hemodynamics or aortic regurgitation; and both groups had significant and comparable improvement in functional and health status after TAVR.