Alhuneafat Laith, Ghanem Fares, Obeidat Omar, Alzyoud Anas, Ma'aita Abdel Latif, Ajam Mustafa, Altibi Ahmed M
Division of Cardiovascular Disease, University of Minnesota, Minneapolis, MN, USA.
Department of Cardiovascular Medicine, Southern Illinois University, Springfield, IL, USA.
Cardiovasc Interv Ther. 2025 Jul 17. doi: 10.1007/s12928-025-01173-y.
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.
经导管主动脉瓣植入术（TAVI） 由于二叶式主动脉瓣（BAV）患者被排除在主要临床试验之外，其严重主动脉瓣狭窄患者的TAVI治疗结果尚不确定。我们使用国际疾病分类第十版（ICD - 10）编码从全国再入院数据库（2016 - 2019年）中提取数据，对美国的TAVI患者进行了分析。我们使用倾向评分匹配（PSM）方法建立了BAV患者和三叶式主动脉瓣（TAV）患者的匹配队列。主要结局指标为住院死亡率、30天死亡率和30天再入院率。在233,683例已识别的TAVI患者中，3169例（1.4%）患有BAV。BAV患者更年轻，合并症更少。经过PSM后，分析了2840对患者。与TAV患者相比，BAV患者的TAVI显示出相当的住院死亡率（1.2%对2.0%；OR 0.62；95% CI 0.36 - 1.04；p = 0.07）和30天再入院率（10.0%对12.3%；OR 0.79；95% CI 0.60 - 1.03；p = 0.08），30天死亡率较低（0.88%对1.96%；OR 0.44；95% CI 0.23 - 0.84；p = 0.01）。BAV和TAV患者TAVI术后的住院并发症发生率，包括中风、急性肾损伤、起搏器植入需求等，相似。与TAV相比，BAV患者的TAVI显示出可接受的安全性，但需要进一步的随机试验来确定长期结局和耐久性。
