Long-Term Durability of Transcatheter Aortic Valves in Patients With Bicuspid Aortic Stenosis

Background: Data concerning the long-term durability of transcatheter aortic valves (TAVs) in patients with bicuspid aortic stenosis (AS) are lacking. Aims: The study aims to report data on long-term valve durability following transcatheter aortic valve replacement (TAVR) in bicuspid AS. Methods: This multicentre registry included patients who underwent TAVR for bicuspid AS with at least 2-year echocardiographic follow-up. The incidence of structural valve deterioration (SVD), bioprosthetic valve dysfunction (BVD), and bioprosthetic valve failure (BVF) was determined according to Valve Academic Research Consortium (VARC)-3 criteria. Results: Among 894 patients (mean age: 75.6 years; 39% female), the median echocardiographic follow-up was 48.7 months with a 5-year cumulative incidence of moderate-to-severe SVD, severe SVD, severe BVD, and BVF of 8.1%, 3.2%, 11.4%, and 6.1%, respectively. Younger age (≤ 75 years) was associated with a higher likelihood of reintervention (HR 2.40, log-rank p = 0.04). TAV downsizing was associated with higher rates of moderate-to-severe SVD (HR 3.05, log-rank p < 0.001), severe BVD (HR 2.07, log-rank p = 0.003), and BVF (HR 3.25, log-rank p = 0.002). In the sub-group with small annuli (area ≤ 430 mm2), implantation of balloon-expandable TAVs was associated with a higher rate of BVD in comparison with self-expanding TAVs (HR: 3.27, log-rank p = 0.008). Conclusions: TAVs demonstrated favorable 5-year durability in patients with bicuspid AS, although younger patients were more likely to require valve reintervention. Nominal TAV sizing was associated with better durability outcomes as compared to TAV downsizing. Self-expanding valves were associated with superior hemodynamics in patients with small annuli.