Comparison of In-Hospital Complication Rates after Transcatheter Aortic Valve Replacement in Patients with Bicuspid Versus Tricuspid Aortic Valves: a Retrospective Cohort Study

Background: Transcatheter aortic valve replacement (TAVR) has become a popular alternative to surgical aortic valve replacement (SAVR) for patients with valvular heart disease (VHD), particularly for those with aortic anomalies. Objectives: The study aimed to compare the risks of post-TAVR complications between patients with bicuspid and tricuspid aortic valves and to identify associated risk factors. Methods: The association between complications and valve type (bicuspid or tricuspid) was assessed. The study also explored various combinations of factors to understand their impact on complications. Separate analyses were conducted to identify specific risk factors for each complication. Results: Out of the 1154 eligible patients, 508 had bicuspid aortic valves (BAV) and 646 had tricuspid aortic valves (TAV). The study identified 40 cases of acute kidney injury, 134 instances of new-onset permanent pacemaker implantations, 129 occurrences of paravalvular leak, and 30 device failures. The comprehensive logistic regression revealed no statistically significant association between complications and valve type (ORs: 0.52 (95%CI, 0.23–1.09) for acute kidney injury, 1.29 (95%CI, 0.87–1.92) for permanent pacemaker implantation, 1.29 (95%CI, 0.82–2.02) for paravalvular leak, and 0.54 (95%CI, 0.22–1.23) for device failure). Total bilirubin (TBIL), albumin (ALB), age, and New York Heart Association (NYHA) scores, among other factors, were associated with specific post-TAVR complications. Conclusions: The incidence of acute kidney injury, new permanent pacemaker implantations, paravalvular leaks, and device failures did not differ significantly between patients with BAV and TAV following TAVR. Specific risk factors for these complications were identified, highlighting the importance of careful clinical monitoring in post-TAVR management.