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Long-Term Outcomes of TAVR vs. SAVR in Bicuspid Aortic Valve Patients: Insights from the real-world practice
Session:
Sessão de Posters 30 - Intervenções valvulares cirúrgicas e transcateter para além da válvula aórtica
Speaker:
Débora Da Silva Correia
Congress:
CPC 2026
Topic:
F. Valvular, Myocardial, Pericardial, Pulmonary, Congenital Heart Disease
Theme:
15. Valvular Heart Disease
Subtheme:
15.4 Valvular Heart Disease – Treatment
Session Type:
Posters Eletrónicos
FP Number:
---
Authors:
Débora da Silva Correia; Catarina Santos-Jorge; Samuel Azevedo; Afonso Félix Oliveira; Sérgio Madeira; Eduardo Infante Oliveira; Luís Raposo; Tiago Nolasco; João Brito; Manuel Almeida; Rui Campante Teles; Pedro Adragão
Abstract
<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Background:</strong> Bicuspid aortic valves (BAV) pose unique challenges for transcatheter aortic valve replacement (TAVR), yet real-world practice increasingly includes TAVR in these patients. However, guideline recommendations remain limited due to scarcity of long-term outcome data.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Aim:</strong> To compare long-term outcomes following surgical aortic valve replacement (SAVR) versus TAVR in patients ≥70 years with BAV.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Methods: </strong>Single-centre, retrospective observational study including consecutive patients aged ≥70 years who underwent TAVR or SAVR between 2017 and 2024 at a tertiary centre. Clinical records were reviewed to obtain baseline characteristics, procedural data, and long-term outcomes, including the progression of bioprosthetic valve dysfunction (BVD) over time and the primary composite endpoint of all-cause mortality and rehospitalization. Procedural outcomes and BVD were assessed using standardized definitions based on VARC-3 criteria.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Results:</strong> A total of 118 patients were included (TAVR n=70; SAVR n=48). TAVR patients were older (81±4.4 vs 73±11.2 years) with worse renal function. SAVR patients presented lower interventional risk. Most cases were elective (80%). Self-expanding valves were used in 76% of TAVR procedures; all SAVR patients received a biological prosthesis. Device success at 30-days was similar between groups (76% in TAVR vs 79% in SAVR, <em>p=</em>0.231). (<strong><em>Table1</em></strong>)</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">The mean follow-up period was 953 ± 763 days. The incidence of BVD did not differ significantly between the groups (7% in TAVR vs 10% in SAVR,<em> p</em>=0.563), predominantly due to non-structural BVD. In the TAVR group, all cases of BVD were due to at least moderate paravalvular regurgitation. In the SAVR group, two patients exhibited prosthesis–patient mismatch, while three developed hemodynamic valve deterioration due to leaflet degeneration, resulting in increased transvalvular gradients (<strong><em>Figure 1</em></strong>). All-cause mortality during follow-up was comparable between groups (TAVR 23% vs SAVR 19%, <em>p=</em>0.592), as were rates of rehospitalization (TAVR 6% vs SAVR 10%, <em>p=</em>0.381). The composite endpoint of death or rehospitalization did not differ significantly between TAVR and SAVR cohorts (26% vs 23%, <em>p=</em>0.729) (<strong><em>Figure 2</em></strong>).</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Conclusion:</strong> In this real-world cohort of patients ≥70 years with bicuspid aortic valves, long-term outcomes were comparable between TAVR and SAVR. These findings suggest that, in contemporary practice, TAVR may offer similar long-term safety and efficacy to SAVR in this population. Larger studies are needed to confirm these results and guide clinical decision-making.</span></span></p>
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