Short-Term Outcomes of Transcatheter Aortic Valve Implantation in Patients with Bicuspid Aortic Valve: Insights from Nationwide Readmission Analysis

Abstract

Transcatheter aortic valve implantation (TAVI) TAVI outcomes for patients with bicuspid aortic valve (BAV) and severe aortic stenosis are uncertain due to their exclusion from major clinical trials. We analyzed TAVI patients in the United States using data from the Nationwide Readmissions Database (2016-2019) identified using ICD-10 codes. We established matched cohorts of BAV and trileaflet aortic valve (TAV) patients using propensity-score matching (PSM). Primary outcomes were in-hospital mortality, 30-day mortality, and 30-day readmission rates. Out of 233,683 TAVI patients identified, 3169 (1.4%) had BAV. BAV patients were younger with fewer comorbidities. After PSM, 2,840 pairs were analyzed. Compared to TAV patients, TAVI in BAV patients showed comparable in-hospital mortality (1.2% vs. 2.0%; OR 0.62; 95% CI 0.36-1.04; p = 0.07) and 30-day readmission rates (10.0% vs. 12.3%; OR 0.79; 95% CI 0.60-1.03; p = 0.08), with lower 30-day mortality rates (0.88% vs. 1.96%; OR 0.44; 95% CI 0.23-0.84; p = 0.01). Post-TAVI in-hospital complications rates, including stroke, acute kidney injury, pacemaker need, and others, were similar between BAV and TAV patients. TAVI in BAV shows acceptable safety compared to TAV, but further randomized trials are needed to establish long-term outcomes and durability.