@article{ACS17818,
author = {Xinmu Li and Peijian Wei and Jianrui Ma and Junke Chang and Fengwen Zhang and Shouzheng Wang and Xiangbin Pan and Jian Liu and Fang Fang},
title = {Outcomes of transcatheter aortic valve replacement in octogenarians and beyond with bicuspid vs. tricuspid aortic stenosis: a retrospective study},
journal = {Annals of Cardiothoracic Surgery},
volume = {0},
number = {0},
year = {2026},
keywords = {},
abstract = {Background: Evidence regarding transcatheter aortic valve replacement (TAVR) in octogenarians with bicuspid aortic valve (BAV) stenosis remains limited. We aimed to characterize the clinical, anatomical, and procedural features and midterm outcomes of patients aged≥80 years with BAV stenosis undergoing TAVR, using patients with tricuspid aortic valve (TAV) stenosis as a clinical reference.Methods: This retrospective single-center study included consecutive patients aged ≥80 years who underwent TAVR for severe aortic stenosis from January 2021 to August 2024. Clinical, imaging, and procedural data were retrieved from institutional electronic medical records; valve morphology was determined using preprocedural computed tomography. The primary outcome was all-cause mortality during follow-up. Secondary outcomes included technical success, cardiovascular mortality, stroke, myocardial infarction, valve thrombosis, aortic valve reintervention, and permanent pacemaker implantation.Results: Among 172 patients, 51 had BAV and 121 had TAV. Patients with BAV had larger aortic root dimensions, greater aortic angulation, and a greater calcification burden. They received larger transcatheter valves (25.96±2.37 vs. 24.98±2.54 mm; P=0.019) and underwent post-dilatation more frequently (23.5% vs. 9.9%; P=0.019). Technical success was similar (90.2% vs. 94.2%; P=0.537), as were discharge transvalvular gradients and paravalvular leak. The average follow-up duration was 33.36±14.37 months. During follow-up, all-cause death occurred in 7/51 (13.7%) and 21/121 (17.4%) patients, respectively (P=0.556), and cardiovascular death in 3/51 (5.9%) and 9/121 (7.4%; P=0.970). Survival analyses showed no significant between-group differences. No valve thrombosis or aortic valve reintervention occurred.Conclusions: Despite greater anatomical and procedural complexity, carefully selected patients aged ≥80 years with BAV showed no statistically significant differences in early valve performance or midterm clinical outcomes compared with those with TAV. These findings may support the consideration of TAVR in this population following comprehensive Heart Team evaluation and CT-based procedural planning.},
issn = {2304-1021}, url = {https://www.annalscts.com/article/view/17818}
}