Author + information
- Received April 26, 2019
- Revision received May 30, 2019
- Accepted June 4, 2019
- Published online September 16, 2019.
- Ayman Elbadawi, MDa,b,∗ (, )@Aymangalal24,
- Marwan Saad, MD, PhDb,c,
- Islam Y. Elgendy, MDd,
- Kirolos Barssoum, MDe,
- Mohamed A. Omer, MDf,
- Ahmed Soliman, MDg,
- Mohamed F. Almahmoud, MDa,
- Gbolahan O. Ogunbayo, MDh,
- Amgad Mentias, MDi,
- Syed Gilani, MDa,
- Hani Jneid, MDj,
- Herbert D. Aronow, MD, MPHc,
- Neil Kleiman, MDg and
- J. Dawn Abbott, MDc
- aDepartment of Cardiovascular Medicine, University of Texas Medical Branch, Galveston, Texas
- bDepartment of Cardiovascular Medicine, Ain Shams University, Cairo, Egypt
- cDivision of Cardiology, Cardiovascular Institute, Warren Alpert Medical School at Brown University, Providence, Rhode Island
- dDivision of Cardiology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
- eDepartment of Internal Medicine, Rochester General Hospital, Rochester, New York
- fDepartment of Cardiovascular Medicine, University of Missouri Kansas City, Kansas City, Missouri
- gDivision of Cardiovascular Medicine, Houston Methodist Hospital, Houston, Texas
- hDepartment of Cardiovascular Medicine, University of Kentucky, Lexington, Kentucky
- iDivision of Cardiovascular Medicine, University of Iowa, Iowa City, Iowa
- jDivision of Cardiovascular Medicine, Baylor College of Medicine, Houston, Texas
- ↵∗Address for correspondence:
Dr. Ayman Elbadawi, Department of Cardiovascular Medicine, University of Texas Medical Branch, 301 University Boulevard, Galveston, Texas 77555.
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.
The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received April 26, 2019.
- Revision received May 30, 2019.
- Accepted June 4, 2019.
- 2019 American College of Cardiology Foundation
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