Transcatheter aortic valve replacement in patients with bicuspid aortic valve stenosis: National trends and in-hospital outcomes
Mohamad Soud1, Yasser Al-khadra2, Fahed Darmoch3, Homam Moussa Pacha4, Zaher Fanari5, M Chadi Alraies6
1 Rutgers New Jersey Medical School, Newark, New Jersey, USA
2 Cleveland Clinic, Medicine Institute, Cleveland, Ohio, USA
3 Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, Massachusetts, USA
4 University of Texas Health Science Center, McGovern Medical School, Houston, Texas, USA
5 Wesley Medical Center, Wichita, KS, USA
6 Wayne State University, Detroit Medical Center, Detroit Heart Hospital, Detroit, Michigan, USA
Dr. M Chadi Alraies
Wayne State University, Detroit Medical Center, Heart Hospital, 311 Mack Ave, Detroit, MI 48201.
Source of Support: None, Conflict of Interest: None
Background: Bicuspid aortic valve (BAV) disease is considered the most common congenital heart disease and the main etiology of aortic valve stenosis (AS) in young adults. Although transcatheter aortic valve replacement (TAVR) is routinely used in high- and intermediate-risk patients with AS, BAV patients with AS were excluded from all pivotal trials that led to TAVR approval. We sought, therefore, to examine in-hospital outcomes of patients with BAV who underwent TAVR in comparison with surgical aortic valve replacement (SAVR). Methods: Using the National Inpatient Sample from 2011 to 2014, we identified patients with BAV with International Classification of Diseases-Ninth Revision-CM code 746.4. Patients who underwent TAVR were identified using ICD-9 codes 35.05 and 35.06 and those who underwent SAVR were identified using codes 35.21 and 35.22 during the same period. Results: A total of 37,052 patients were found to have BAV stenosis. Among them, 36,629 patients (98.8%) underwent SAVR, whereas 423 patients (1.14%) underwent TAVR. One-third of enrolled patients were female, and the majority of the patients were White with a mean age of 65.9 ± 15.1 years. TAVR use for BAV stenosis significantly increased from 0.39% in 2011 to 4.16% in 2014 (P < 0.001), which represents a 3.77% overall growth in procedure rate. The median length of stay decreased significantly throughout the study period (mean 12.2 ± 8.2 days to 7.1 ± 5.9 days, P < 0.001). There was no statistically significant difference between SAVR and TAVR groups in the in-hospital mortality (0% vs. 5.9%; adjusted P = 0.119). Conclusion: There is a steady increase in TAVR use for BAV stenosis patients along with a significant decrease in length of stay.