Background: Evidence regarding transcatheter aortic valve implantation (TAVI) in young (≤ 75 years) low-risk patients with bicuspid aortic valve (BAV) stenosis deemed unsuitable for surgery is scarce. Objectives: To investigate in-hospital and follow-up outcomes in this population compared with older or higher-risk patients. Methods: This retrospective international registry included 980 patients with severe BAV stenosis undergoing TAVI, stratified in: Group I, < 69 years and Society of Thoracic Surgeons predicted mortality (STS-PROM) < 4 (N = 113); Group II, 69–75 years and STS-PROM < 4 (N = 173); Group III, > 75 years or STS-PROM ≥ 4 (N = 694). Endpoints included technical success, 30-day device success and safety, transcatheter heart valve (THV) function during follow-up, survival and freedom from transient ischemic attack (TIA)/stroke or heart failure hospitalization. Results: Technical success was comparable (Group I: 94.7%, Group II: 97.1%, Group III: 94.5%; P = 0.37), as were 30-day device success (P = 0.45) and safety (P = 0.29). Regression analyses revealed stable mean transvalvular gradients over follow-up with no differential temporal trends across groups (P = 0.93), and no association between follow-up time and PVL severity (P = 0.17); younger patients showed lower odds of mild PVL compared with older patients. Severe valve deterioration did not occur in Group I and II, versus 3 cases (0.4%) in Group III. Bioprosthesis valve failure rate remained < 2% and similar across groups (P = 0.53). Freedom from TIA/stroke or heart failure rehospitalization was higher in Group I (91.1%) and II (93.8%) than in Group III (81.0%, P = 0.006). Conclusions: TAVI in young, low-risk BAV patients deemed unsuitable for surgery showed favorable in-hospital outcomes comparable to those of older or higher-risk patients, with stable valve hemodynamics during follow-up.
Gorla, R., Sturla, F., Pensotti, F., Buono, A., Zito, A., Del Sole, P. A., Bellini, B., Montarello, N. J., Kobari, Y., De Biase, C., Costa, G., Calì, M., Fabris, T., Putorti, F., Massussi, M., Costa, G., Bellamoli, M., Garcia Gomez, M., Giacomin, E., Scotti, A., Cattaneo, G., Pellicano, M., Galasso, M., Gitto, M., Renker, M., Leone, P. P., Esposito, G., Trani, C., Orzalkiewicz, M., Saia, F., Ielasi, A., Orbach, A., Brambilla, N., Barbanti, M., Burzotta, F., Blackman, D. J., Briguori, C., Hug, K., Rheude, T., Chen, M., Koren, O., Makkar, R. R., Latib, A., Favero, L., Mangieri, A., Adamo, M., De Carlo, M., Amat Santos, I., Maffeo, D., Tchètchè, D., De Backer, O., Tarantini, G., Montorfano, M., Kim, W., Mylotte, D., Testa, L., Bedogni, F., TAVI in young patients with bicuspid aortic valve stenosis: insight from the international AD-HOC registry, <<CLINICAL RESEARCH IN CARDIOLOGY>>, 2026; (Apr 20): N/A-N/A. [doi:10.1007/s00392-026-02892-9] [https://hdl.handle.net/10807/337109]
TAVI in young patients with bicuspid aortic valve stenosis: insight from the international AD-HOC registry
Buono, Andrea;Zito, Andrea;Esposito, Giovanni;Trani, Carlo;Saia, Francesco;Burzotta, Francesco;Tarantini, Giuseppe;Testa, Luca;Bedogni, Francesco
2026
Abstract
Background: Evidence regarding transcatheter aortic valve implantation (TAVI) in young (≤ 75 years) low-risk patients with bicuspid aortic valve (BAV) stenosis deemed unsuitable for surgery is scarce. Objectives: To investigate in-hospital and follow-up outcomes in this population compared with older or higher-risk patients. Methods: This retrospective international registry included 980 patients with severe BAV stenosis undergoing TAVI, stratified in: Group I, < 69 years and Society of Thoracic Surgeons predicted mortality (STS-PROM) < 4 (N = 113); Group II, 69–75 years and STS-PROM < 4 (N = 173); Group III, > 75 years or STS-PROM ≥ 4 (N = 694). Endpoints included technical success, 30-day device success and safety, transcatheter heart valve (THV) function during follow-up, survival and freedom from transient ischemic attack (TIA)/stroke or heart failure hospitalization. Results: Technical success was comparable (Group I: 94.7%, Group II: 97.1%, Group III: 94.5%; P = 0.37), as were 30-day device success (P = 0.45) and safety (P = 0.29). Regression analyses revealed stable mean transvalvular gradients over follow-up with no differential temporal trends across groups (P = 0.93), and no association between follow-up time and PVL severity (P = 0.17); younger patients showed lower odds of mild PVL compared with older patients. Severe valve deterioration did not occur in Group I and II, versus 3 cases (0.4%) in Group III. Bioprosthesis valve failure rate remained < 2% and similar across groups (P = 0.53). Freedom from TIA/stroke or heart failure rehospitalization was higher in Group I (91.1%) and II (93.8%) than in Group III (81.0%, P = 0.006). Conclusions: TAVI in young, low-risk BAV patients deemed unsuitable for surgery showed favorable in-hospital outcomes comparable to those of older or higher-risk patients, with stable valve hemodynamics during follow-up.
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