Temporal Trends and Outcomes of Transcatheter Versus Surgical Aortic Valve Replacement for Bicuspid Aortic Valve Stenosis

A. Elbadawi, Marwan Saad, Islam Y. Elgendy, Kirolos Barssoum, Mohamed A. Omer, A. Soliman, Mohamed F. Almahmoud, Gbolahan O. Ogunbayo, A. Mentias, Syed Gilani, Hani Jneid, Herbert D. Aronow, Neil Kleiman, J. Dawn Abbott

Research output: Contribution to journalArticle

Abstract

Objectives: The purpose of this study was to assess the temporal trends of transcatheter aortic valve replacement (TAVR) in patients with bicuspid aortic stenosis (AS), and to compare the outcomes between TAVR and surgical aortic valve replacement (SAVR) in this population. Background: Randomized trials comparing TAVR to SAVR in AS with bicuspid valve are lacking. Methods: The study queried the National Inpatient Sample database (years 2012 to 2016) to identify hospitalizations for bicuspid AS who underwent isolated aortic valve replacement. A propensity-matched analysis was used to compare outcomes of hospitalizations for TAVR versus SAVR for bicuspid AS and TAVR for bicuspid AS versus tricuspid AS. Results: The analysis included 31,895 hospitalizations with bicuspid AS, of whom 1,055 (3.3%) underwent TAVR. TAVR was increasingly utilized during the study period for bicuspid AS (ptrend = 0.002). After matching, TAVR and SAVR had similar in-hospital mortality (3.1% vs. 3.1%; odds ratio: 1.00; 95% confidence interval: 0.60 to 1.67). There was no difference between TAVR and SAVR in the rates of cardiac arrest, cardiogenic shock, acute kidney injury, hemopericardium, cardiac tamponade, or acute stroke. TAVR was associated with lower rates of acute myocardial infarction, post-operative bleeding, vascular complications, and discharge to nursing facility as well as a shorter length of hospital stay. On the contrary, TAVR was associated with a higher incidence of complete heart block and permanent pacemaker insertion. TAVR for bicuspid AS was associated with similar in-hospital mortality compared with tricuspid AS. Conclusions: This nationwide analysis showed similar in-hospital mortality for TAVR and SAVR in patients with bicuspid AS. TAVR for bicuspid AS was also associated with similar in-hospital mortality compared with tricuspid AS. Further studies are needed to evaluate long-term outcomes of TAVR for bicuspid AS.

Original languageEnglish (US)
Pages (from-to)1811-1822
Number of pages12
JournalJACC: Cardiovascular Interventions
Volume12
Issue number18
DOIs
StatePublished - Sep 23 2019

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Aortic Valve Stenosis
Aortic Valve
Surgical Instruments
Bicuspid
Hospital Mortality
Hospitalization
Transcatheter Aortic Valve Replacement
Bicuspid Aortic Valve
Length of Stay
Cardiac Tamponade
Heart Block
Cardiogenic Shock
Pericardial Effusion
Population Dynamics
Heart Arrest
Mitral Valve
Acute Kidney Injury
Blood Vessels
Inpatients

Keywords

  • bicuspid aortic valve
  • surgical aortic valve replacement
  • transcatheter aortic valve replacement

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Temporal Trends and Outcomes of Transcatheter Versus Surgical Aortic Valve Replacement for Bicuspid Aortic Valve Stenosis. / Elbadawi, A.; Saad, Marwan; Elgendy, Islam Y.; Barssoum, Kirolos; Omer, Mohamed A.; Soliman, A.; Almahmoud, Mohamed F.; Ogunbayo, Gbolahan O.; Mentias, A.; Gilani, Syed; Jneid, Hani; Aronow, Herbert D.; Kleiman, Neil; Abbott, J. Dawn.

In: JACC: Cardiovascular Interventions, Vol. 12, No. 18, 23.09.2019, p. 1811-1822.

Research output: Contribution to journalArticle

Elbadawi, A, Saad, M, Elgendy, IY, Barssoum, K, Omer, MA, Soliman, A, Almahmoud, MF, Ogunbayo, GO, Mentias, A, Gilani, S, Jneid, H, Aronow, HD, Kleiman, N & Abbott, JD 2019, 'Temporal Trends and Outcomes of Transcatheter Versus Surgical Aortic Valve Replacement for Bicuspid Aortic Valve Stenosis', JACC: Cardiovascular Interventions, vol. 12, no. 18, pp. 1811-1822. https://doi.org/10.1016/j.jcin.2019.06.037
Elbadawi, A. ; Saad, Marwan ; Elgendy, Islam Y. ; Barssoum, Kirolos ; Omer, Mohamed A. ; Soliman, A. ; Almahmoud, Mohamed F. ; Ogunbayo, Gbolahan O. ; Mentias, A. ; Gilani, Syed ; Jneid, Hani ; Aronow, Herbert D. ; Kleiman, Neil ; Abbott, J. Dawn. / Temporal Trends and Outcomes of Transcatheter Versus Surgical Aortic Valve Replacement for Bicuspid Aortic Valve Stenosis. In: JACC: Cardiovascular Interventions. 2019 ; Vol. 12, No. 18. pp. 1811-1822.
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AU - Elbadawi, A.

AU - Saad, Marwan

AU - Elgendy, Islam Y.

AU - Barssoum, Kirolos

AU - Omer, Mohamed A.

AU - Soliman, A.

AU - Almahmoud, Mohamed F.

AU - Ogunbayo, Gbolahan O.

AU - Mentias, A.

AU - Gilani, Syed

AU - Jneid, Hani

AU - Aronow, Herbert D.

AU - Kleiman, Neil

AU - Abbott, J. Dawn

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N2 - Objectives: The purpose of this study was to assess the temporal trends of transcatheter aortic valve replacement (TAVR) in patients with bicuspid aortic stenosis (AS), and to compare the outcomes between TAVR and surgical aortic valve replacement (SAVR) in this population. Background: Randomized trials comparing TAVR to SAVR in AS with bicuspid valve are lacking. Methods: The study queried the National Inpatient Sample database (years 2012 to 2016) to identify hospitalizations for bicuspid AS who underwent isolated aortic valve replacement. A propensity-matched analysis was used to compare outcomes of hospitalizations for TAVR versus SAVR for bicuspid AS and TAVR for bicuspid AS versus tricuspid AS. Results: The analysis included 31,895 hospitalizations with bicuspid AS, of whom 1,055 (3.3%) underwent TAVR. TAVR was increasingly utilized during the study period for bicuspid AS (ptrend = 0.002). After matching, TAVR and SAVR had similar in-hospital mortality (3.1% vs. 3.1%; odds ratio: 1.00; 95% confidence interval: 0.60 to 1.67). There was no difference between TAVR and SAVR in the rates of cardiac arrest, cardiogenic shock, acute kidney injury, hemopericardium, cardiac tamponade, or acute stroke. TAVR was associated with lower rates of acute myocardial infarction, post-operative bleeding, vascular complications, and discharge to nursing facility as well as a shorter length of hospital stay. On the contrary, TAVR was associated with a higher incidence of complete heart block and permanent pacemaker insertion. TAVR for bicuspid AS was associated with similar in-hospital mortality compared with tricuspid AS. Conclusions: This nationwide analysis showed similar in-hospital mortality for TAVR and SAVR in patients with bicuspid AS. TAVR for bicuspid AS was also associated with similar in-hospital mortality compared with tricuspid AS. Further studies are needed to evaluate long-term outcomes of TAVR for bicuspid AS.

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