Cardiovascular

Transcatheter aortic valve replacement in bicuspid versus tricuspid aortic valves among patients with mixed aortic valve disease.

Tan B, Zhu Q, et al. • BMC cardiovascular disorders • 2026

PubMed 42977929 DOI 10.1186/s12872-026-06802-9
TL;DR

In MAVD patients undergoing TAVR, bicuspid and tricuspid valve morphologies demonstrated comparable long-term clinical outcomes, with BAV patients showing greater improvements in left ventricular function and transvalvular hemodynamics.

Key Findings

Results

BAV patients made up about a third of this MAVD TAVR cohort and were younger and lower-risk than TAV patients.

  • 610 MAVD patients undergoing TAVR between March 2013 and December 2024 were included.
  • 220 patients (36.1%) had BAV morphology.
  • BAV patients were younger (73 vs. 75 years, p < 0.001).
  • BAV patients had a lower STS score (3.47% vs. 4.15%, p < 0.001).
Results

Unadjusted five-year mortality was lower in BAV than TAV patients.

  • Five-year mortality was 10.5% in bicuspid vs. 18.7% in tricuspid patients (log-rank p = 0.014).
  • MAVD was defined as severe AS with concomitant moderate or greater aortic regurgitation.
Results

BAV was not an independent predictor of five-year all-cause mortality after multivariable adjustment.

  • Cox regression: HR 0.75, 95% CI 0.47-1.22, p = 0.253.
  • The crude mortality difference therefore did not persist after adjustment, consistent with the authors' conclusion of comparable long-term outcomes.
Results

BAV patients showed greater one-year improvement in aortic valve area and LVEF than TAV patients.

  • Greater increase in AVA (p for interaction = 0.012).
  • Greater increase in LVEF (p for interaction = 0.011).
  • Echocardiographic follow-up was performed during the one-year period after the procedure.
Results

BAV patients showed a greater reduction in transvalvular mean gradient and peak velocity during one-year follow-up.

  • Both mean gradient and peak velocity reductions had p for interaction < 0.001.
Results

Left ventricular reverse remodelling was similar between BAV and TAV groups during follow-up.

  • Both p for trend < 0.001, indicating significant remodelling over time in the cohort.
  • The abstract describes the remodelling as similar between morphologies.
Conclusions

The authors conclude that bicuspid morphology does not confer an adverse long-term prognostic effect in appropriately selected MAVD patients undergoing TAVR.

  • Long-term clinical outcomes were comparable between BAV and TAV.
  • The authors note that prior studies rarely distinguished bicuspid morphology in MAVD and that no study had evaluated long-term TAVR outcomes by BAV vs. TAV in this setting.
  • Registered as NCT02803294.

What This Means

This study looked at 610 people with both a narrowed aortic valve and a leaky one (mixed aortic valve disease) who had a transcatheter aortic valve replacement (TAVR) between 2013 and 2024. About 36% had a bicuspid valve (two flaps instead of the usual three), and these patients tended to be younger and have a lower surgical risk score. Bicuspid patients had lower five-year death rates at first glance (10.5% vs. 18.7%). However, once the researchers accounted for differences between the groups, such as age and risk score, the difference was no longer statistically significant. This suggests bicuspid valves did not make long-term survival worse. Over the first year, bicuspid patients also showed larger improvements in valve opening area, heart pumping function, and blood-flow measures, and both groups showed similar signs of the heart's left ventricle recovering. This research suggests that having a bicuspid valve by itself should not be viewed as a factor leading to worse long-term outcomes after TAVR in carefully selected patients with mixed valve disease. The study was observational, so it cannot prove cause and effect, and results apply to patients selected for TAVR at the participating centers.

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Citation

Tan B, Zhu Q, Liu Q, Sheng W, Ren K, Guo Y, et al.. (2026). Transcatheter aortic valve replacement in bicuspid versus tricuspid aortic valves among patients with mixed aortic valve disease.. BMC cardiovascular disorders. https://doi.org/10.1186/s12872-026-06802-9