The following is a summary of “Transcatheter Aortic Valve Implantation (TAVI) in Bicuspid Aortic Valve Disease: A Systematic Review,” published in the September 2024 issue of Cardiology by Goulden et al.
Transcatheter aortic valve implantation (TAVI) was effective and safe, but its outcomes for patients with bicuspid aortic valve (BAV) disease were relatively unclear.
Researchers conducted a retrospective study evaluating the effectiveness and safety of TAVI in patients with BAV disease.
They conducted a comprehensive search of PubMed, Medline, and Google Scholar (November 2023) to identify studies evaluating TAVI in patients with BAV. Inclusion criteria were applied, and clinical and procedural outcomes data were extracted, including echocardiographic measures and complications. Statistical analyses included descriptive statistics, subgroup analysis, and sensitivity analysis.
The results showed 29 studies covering 8,045 patients with BAV; the mean age was 72.5 ± 10.35 years with a male predominance of 56.4% ± 7.9%. The TAVI was significantly beneficial, decreasing the mean aortic gradient from 46.9 to 10.4 mm Hg post-procedure and increasing the aortic valve area, evidencing improved hemodynamics. A high procedural success rate of 93.3% was noted, predominantly through femoral access. However, complications included pacemaker need (12.6%), minor bleeding, and acute kidney injury. All-cause mortality escalated from 3.7% perioperatively to 16.8% after 1 year; HR and P values highlighted significant outcomes: perioperative HR for mortality at 3.7% (P<0.05), reduction in perioperative versus postoperative gradients (P<0.001), and increase in postoperative aortic valve area (P<0.001). The need for post-dilatation was less than dilatation (P<0.05), and significant differences were noted in device sizes (P<0.05).
They concluded that TAVI in patients with BAV showed good perioperative outcomes but with moderate complication rates with a significant rise in 1-year mortality, underscoring the importance of careful patient selection and strict postoperative care.
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