Surgical Versus Transcatheter Aortic Valve Replacement in Bicuspid Aortic Stenosis: 1-Year Clinical Outcomes in Patients Aged 65 Years and Older

BACKGROUND: Transcatheter aortic valve replacement (TAVR) has shown noninferiority to surgical aortic valve replacement (SAVR). However, patients with bicuspid aortic stenosis are often excluded from these studies. More insights between these procedures in this population is crucial for treatment selection. METHODS: In this multicenter observational study, patients with bicuspid aortic stenosis undergoing TAVR or SAVR were analyzed using propensity score matching. The primary outcome was a composite of all-cause mortality, stroke, rehospitalization, or valve dysfunction at 1 year. RESULTS: A total of 997 patients with bicuspid aortic stenosis underwent TAVR or SAVR. In the matched cohort of 256 pairs, the median age was 75.0 years (interquartile range, 71.0-78.0), 234 (44.9%) were women, and the median EuroScore II was 1.83% (interquartile range, 1.34-2.86). One-year cumulative incidence of the primary outcome was 15.0% in TAVR compared with 12.0% in SAVR (hazard ratio [HR], 1.35 [95% CI, 0.83-2.19], P=0.23). Mortality (4.3% versus 5.0%, P=0.72) and rehospitalization (4.8% versus 6.4%, P=0.45) were similar between groups. Although rates of valve dysfunction (2.9% versus 0.5%, P=0.06) and stroke (5.3% versus 2.3%, P=0.10) were numerically lower in the surgical group at 1 year, both the risk of stroke (subdistribution HR, 3.01, P=0.02) and valve dysfunction (subdistribution HR, 4.16, P=0.03) were significantly higher in the TAVR group at 2 years. CONCLUSIONS: TAVR in patients with bicuspid aortic stenosis showed a similar 1-year primary outcome rate compared with SAVR, though TAVR exhibited higher rates of valve dysfunction and stroke. These findings underscore the need for randomized trials to define the optimal treatment strategy for this population.