Safety and efficacy of transcatheter aortic valve replacement (TAVR) vs. surgical aortic valve replacement (SAVR) in patients with bicuspid aortic stenosis: A Systematic review and meta-analysis.

In 30 seconds

This systematic review and meta-analysis compared transcatheter (TAVR) with surgical aortic valve replacement (SAVR) for bicuspid aortic stenosis, combining one randomised trial and 13 cohort studies involving 78,677 patients. TAVR was associated with more permanent pacemaker implantation (O.R. = 2.29, 95% C.I. [1.51, 3.47], P < 0.01), but less bleeding and shorter hospital stays. All-cause mortality, acute kidney injury, stroke, and vascular complications did not differ significantly overall; long-term stroke incidence was higher with TAVR in follow-up subgroup analysis.

Key findings

• Permanent pacemaker implantation was more frequent with TAVR than SAVR (O.R. = 2.29, 95% C.I. [1.51, 3.47], P < 0.01).
• TAVR was associated with lower bleeding rates (O.R. = 0.31, 95% C.I. [0.14, 0.69], P < 0.01) and shorter hospital stays (M.D. = -2.24, 95% C.I. [-3.96, -0.52], P = 0.01).
• Overall, there were no significant differences in all-cause mortality, acute kidney injury, stroke, or vascular complications; long-term stroke incidence was higher with TAVR in subgroup analysis.

Why it matters

Bicuspid valve anatomy has made TAVR evidence less established than for other aortic stenosis populations. These pooled findings outline trade-offs relevant to comparing procedural approaches: TAVR was associated with less bleeding and shorter hospitalisation, but more pacemaker implantation, with a signal for higher long-term stroke. The evidence therefore supports weighing outcomes rather than assuming one approach is uniformly safer.

What to keep in mind

The evidence was dominated by observational studies (12 retrospective and one prospective cohort, alongside one randomised trial), so pooled comparisons may be affected by confounding. The abstract does not report long-term follow-up duration.