Safety and efficacy of transcatheter aortic valve implantation in bicuspid aortic valve stenosis: a propensity-matched multicentre study

Background Current evidence regarding transcatheter aortic valve implantation (TAVI) in bicuspid aortic valve (BAV) is primarily based on Western registries, whereas data from Africa and the Middle East are scarce.Objectives To assess the safety and efficacy of contemporary TAVI in patients with BAV, in comparison with tricuspid aortic valve (TAV).Methods This prospective multicenter observational study included consecutive patients undergoing TAVI between June 2021 and June 2024 at two tertiary centers in Egypt. Patients were classified as BAV (n = 50) or TAV (n = 267). Outcomes were adjudicated in accordance with Valve Academic Research Consortium-3 (VARC-3) criteria, with follow-up extending to 12 months. Propensity score (PS) matching (1:1) was applied to achieve balance in baseline characteristics.Results Compared to TAV, BAV anatomy was associated with higher transvalvular gradients (p = 0.024), larger ascending aortic diameters (p < 0.001), greater leaflet calcification, and a higher prevalence of basal septal calcification (p = 0.006). Balloon pre-dilatation (86% vs. 38%) and post-dilatation (50% vs. 20%) were more frequently performed in BAV patients (both p < 0.001). Device success at 30 days was comparable between groups (84% in TAV vs. 92% in BAV, p = 0.357). The incidence of all-cause mortality, stroke, and new permanent pacemaker (PPM) implantation at 1 year did not differ meaningfully between groups.Conclusions In this prospective multicenter cohort, contemporary TAVI achieved early and mid-term outcomes in carefully selected BAV patients comparable to tricuspid anatomy. These findings suggest the feasibility of TAVI in carefully selected BAV anatomies when guided by detailed computed tomography (CT)-based assessment and tailored procedural planning.