In propensity score-matched patients undergoing TAVR with contemporary balloon-expandable valves, long-term clinical outcomes, valve performance, and ascending aortic growth rate showed no statistically significant differences between bicuspid and tricuspid groups.
All-cause mortality at 5 years did not differ significantly between bicuspid and tricuspid patients following TAVR with contemporary balloon-expandable valves.
Heart failure rehospitalization, stroke, and aortic valve reintervention rates at 5 years were not significantly different between bicuspid and tricuspid groups.
Valve hemodynamic performance through 5 years was not significantly different between bicuspid and tricuspid groups.
Ascending aortic growth rates were not significantly different between bicuspid and tricuspid patients after TAVR.
A propensity score-matched analysis was used to compare 515 bicuspid-tricuspid patient pairs undergoing TAVR with contemporary balloon-expandable valves.
This research suggests that patients with bicuspid aortic valves — a congenital heart condition where the aortic valve has two leaflets instead of the normal three — can achieve outcomes comparable to patients with normal three-leaflet (tricuspid) valves when treated with transcatheter aortic valve replacement (TAVR) using modern balloon-expandable devices. The study followed over 3,300 patients for a median of more than four years, and after carefully matching bicuspid and tricuspid patients to make fair comparisons, found no meaningful differences in survival, heart failure hospitalizations, strokes, or the need for a second valve procedure. The study also found that the replaced valves functioned similarly in both groups over five years, with comparable pressure gradients across the valve and similar rates of valve leakage. Importantly, the rate at which the main artery from the heart (the ascending aorta) grew over time was also similar between groups — a notable finding because people with bicuspid valves are known to be at higher risk for aortic enlargement, which can be a serious complication. This research is significant because bicuspid aortic valve disease has historically been considered a relative contraindication or high-risk condition for TAVR, with many centers preferring open-heart surgery for these patients. These findings suggest that with contemporary balloon-expandable devices and modern procedural techniques, TAVR may be a viable long-term treatment option for carefully selected bicuspid patients, though the authors note that limited data availability has been a challenge in this area and continued study is warranted.
Suruga K, Patel V, Shitan H, Yuchao G, Nagasaka T, Ng D, et al.. (2026). Long-Term Outcomes of Contemporary Balloon-Expandable TAVR in Bicuspid Aortic Valve: A Propensity-Matched Comparison to Tricuspid.. JACC. Cardiovascular interventions. https://doi.org/10.1016/j.jcin.2026.06.015