Surgical vs TranscatheterJACCFriday, August 28, 2026

Transcatheter Aortic Valve Replacement for Severe Bicuspid Aortic Valve Stenosis: A Systematic Review and Meta-Analysis.

1 min read·By E. Nolan Beckett, MD·Source: JACC. Advances

Key Numbers

95% CIs

95% CI

P < 0.001

P = 0.020

From The Valve Wire

This meta-analysis of 52 studies delivers the most comprehensive picture to date of TAVR in bicuspid anatomy.

Against tricuspid controls (39 studies), BAV TAVR carried higher paravalvular leak (RR 1.44), aortic root injury (RR 1.83), 30-day stroke (RR 1.27), and 30-day mortality (RR 1.25) — yet paradoxically lower 1-year mortality (RR 0.84), a discordance the authors attribute to STS score rather than valve morphology.

Against SAVR in BAV (13 studies), TAVR had markedly higher PVL (RR 7.08) and less major bleeding, with no early mortality difference.

BAV TAVR outcomes improved year-over-year (RR 0.93 per year).

Source Abstract

BACKGROUND: Comparative outcomes of transcatheter aortic valve replacement (TAVR) in bicuspid aortic valve (BAV) stenosis remain uncertain. OBJECTIVES: The authors synthesized evidence comparing: 1) TAVR outcomes in BAV vs tricuspid aortic valve (TAV) stenosis; and 2) TAVR vs surgical aortic valve replacement (SAVR) among patients with BAV stenosis. METHODS: MEDLINE, Scopus, and Cochrane CENTRAL were searched through January 31, 2026 (CRD420261304542). Random-effects models pooled risk ratios (RRs) with 95% CIs. Exploratory meta-regression assessed study-level modifiers and temporal trends in 1-year mortality. RESULTS: Fifty-two studies were included. In 39 studies comparing TAVR in BAV vs TAV, BAV was associated with higher paravalvular leak (RR: 1.44; 95% CI: 1.18-1.77; P < 0.001), aortic root injury (RR: 1.83; 95% CI: 1.10-3.04; P = 0.020), 30-day stroke (RR: 1.27; 95% CI: 1.02-1.59; P = 0.035), and 30-day mortality (RR: 1.25; 95% CI: 1.00-1.55; P = 0.047), but lower 1-year mortality (RR: 0.84; 95% CI: 0.75-0.94; P = 0.002). The Society of Thoracic Surgeons score-but not BAV anatomy-predicted 1-year mortality (RR: 1.31; 95% CI: 1.08-1.59; P = 0.006). BAV outcomes improved in recent studies (RR per year, 0.93; 95% CI: 0.87-1.00; P = 0.048). In 13 studies comparing TAVR vs SAVR in BAV, TAVR had higher paravalvular leak (RR: 7.08; 95% CI: 2.28-21.98; P < 0.001) and lower major bleeding (RR: 0.27; 95% CI: 0.17-0.44; P < 0.001) but similar 30-day stroke (P = 0.288) and mortality (P = 0.452). CONCLUSIONS: TAVR for BAV stenosis was associated with procedural risk than TAVR for TAV stenosis but lower 1-year mortality. Compared with SAVR, TAVR showed procedural trade-offs without early mortality differences.

Authors: Kumar S, Ahn JM, Ko E, Mohammed G, Hayashida K et al.

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