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Background <p>Evidence regarding transcatheter aortic valve implantation (TAVI) in young (≤ 75&#xa0;years) low-risk patients with bicuspid aortic valve (BAV) stenosis deemed unsuitable for surgery is scarce.</p> Objectives <p>To investigate in-hospital and follow-up outcomes in this population compared with older or higher-risk patients.</p> Methods <p>This retrospective international registry included 980 patients with severe BAV stenosis undergoing TAVI, stratified in: Group I, &lt; 69&#xa0;years and Society of Thoracic Surgeons predicted mortality (STS-PROM) &lt; 4 (<i>N</i> = 113); Group II, 69–75&#xa0;years and STS-PROM &lt; 4 (<i>N</i> = 173); Group III, &gt; 75&#xa0;years or STS-PROM ≥ 4 (<i>N</i> = 694).</p> <p>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.</p> Results <p>Technical success was comparable (Group I: 94.7%, Group II: 97.1%, Group III: 94.5%; <i>P</i> = 0.37), as were 30-day device success (<i>P</i> = 0.45) and safety (<i>P</i> = 0.29). Regression analyses revealed stable mean transvalvular gradients over follow-up with no differential temporal trends across groups (<i>P</i> = 0.93), and no association between follow-up time and PVL severity (<i>P</i> = 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 &lt; 2% and similar across groups (<i>P</i> = 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%, <i>P</i> = 0.006).</p> Conclusions <p>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.</p> Graphical Abstract <p>TAVI outcomes in young, low-risk patients with bicuspid aortic valve patients from the AD-HOC international registry</p> <p></p>

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TAVI in young patients with bicuspid aortic valve stenosis: insight from the international AD-HOC registry

  • 期刊论文

  • 发表日期：

    2026年4月20日

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  • Riccardo Gorla,
  • Francesco Sturla,
  • Filippo Pensotti,
  • Andrea Buono,
  • Andrea Zito,
  • Paolo Alberto Del Sole,
  • Barbara Bellini,
  • Nicholas Joseph Montarello,
  • Yusuke Kobari,
  • Chiara De Biase,
  • Giuliano Costa,
  • Mariachiara Calì,
  • Tommaso Fabris,
  • Francesco Putorti,
  • Mauro Massussi,
  • Giulia Costa,
  • Michele Bellamoli,
  • Mario Garcia Gomez,
  • Enrico Giacomin,
  • Andrea Scotti,
  • Greta Cattaneo,
  • Mariano Pellicano,
  • Michele Galasso,
  • Mauro Gitto,
  • Matthias Renker,
  • Pier Pasquale Leone,
  • Giovanni Esposito,
  • Carlo Trani,
  • Mateusz Orzalkiewicz,
  • Francesco Saia,
  • Alfonso Ielasi,
  • Ady Orbach,
  • Nedy Brambilla,
  • Marco Barbanti,
  • Francesco Burzotta,
  • Daniel J. Blackman,
  • Carlo Briguori,
  • Karsten Hug,
  • Tobias Rheude,
  • Mao Chen,
  • Ofir Koren,
  • Raj R. Makkar,
  • Azeem Latib,
  • Luca Favero,
  • Antonio Mangieri,
  • Marianna Adamo,
  • Marco De Carlo,
  • Ignacio Amat Santos,
  • Diego Maffeo,
  • Didier Tchètchè,
  • Ole De Backer,
  • Giuseppe Tarantini,
  • Matteo Montorfano,
  • Won-Keun Kim,
  • Darren Mylotte,
  • Luca Testa,
  • Francesco Bedogni

摘要

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.

Graphical Abstract

TAVI outcomes in young, low-risk patients with bicuspid aortic valve patients from the AD-HOC international registry