Abstract
IntroductionBicuspid aortic valve (BAV) disease is considered the most common congenital heart disease and the main etiology of aortic valve stenosis (AS) in young adults. While transcatheter aortic valve replacement (TAVR) is routinely used in high- and intermediate risk patients with AS, BAV patients with AS were excluded from all pivotal trials that led to TAVR approval.HypothesisWe sought to examine TAVR trends and in-hospital outcomes in patients with BAV AS.MethodsUsing the National Inpatient Sample (NIS) from January 1, 2011, through December 31, 2014. We identified patients with BAV with International Classification of Diseases-Ninth Revision-CM (ICD-9) code 746.4. Patients who underwent TAVR were identified using ICD-9 codes 35.05 and 35.06. Baseline characteristics were created from definitions in the Elixhauser Comorbidity Index.ResultsWe identified 423 patients with BAV and AS who underwent TAVR which represents 2.1% of the total BAV patients. One-third of enrolled patients were female, and the majority of the patients were white with a mean age of 65.9±15.1 years. TAVR utilization for BAV stenosis significantly increased from 0.39% in 2011 to 4.16% in 2014 (p < 0.001) which represents a 3.77% overall growth in procedure rate. The median length of stay decreased significantly throughout the study period [mean 12.2±8.2 days to 7.1±5.9 days, p-value <0.001]. The overall vascular complications, the need for blood transfusion and the requirement for emergent open cardiac surgery have declined over the same period.ConclusionsDespite lack of FDA approval, there is a steady increase in TAVR utilization for BAV patients with AS along with a significant decrease in length of stay and procedural complications.