Efficacy and safety of Transcatheter Aortic Valve Replacement in patients with stenotic bicuspid aortic valve: a meta-analysis

Objective: To assess clinical outcomes of Transcatheter Aortic Valve Replacement in stenotic bicuspid aortic valve patients. Methods: The search of clinical articles was conducted by using Pubmed, Embase, The Cochrane Library databases. We compared clinical outcomes of efficacy and safety endpoints between stenotic bicuspid aortic valve(BAV) and tricuspid aortic valve(TAV) patients according to Valve Academic Research Consortium-2 criteria. Results: 20 studies were included in the current meta analysis. BAV groups showed higher post-procedural paravalvular leakage and stroke rate compared with TAV groups. No discrepancy were detected in the mean aortic gradient and aortic valve area between two groups. The 30-day and 1-year mortality were similar in both groups. BAV group was more likely to be associated with lower device success and higher incidence of conversion to surgical aortic valve replacement, second valve implantation and annular rupture. No difference was found in the incidence of permanent pacemaker implantation, acute kidney disease, life-threatening bleeding and myocardial infarction between bicuspid and tricuspid patients. Conclusion: The efficacy and safety of TAVR in BAV patients were not as ideal as those in TAV patients. Cautious and adequate discussion must be made before we decide to perform TAVR procedure for BAV patients.