Abstract

Objective: To quantify the comparative results of TAVR, systematic review and meta-analysis of short- and intermediate-term results of TAVR in low-risk AS excluding BAV patients was performed. Methods: PubMed, Scopus, Embase and the Cochrane central register of controlled trials were queried for studies reporting outcomes of TAVR in bicuspid and tricuspid anatomy in low surgicalrisk patients between January 2020 and December 2025. Across six propensity matched/comparative studies (N = 8682 patients), the patients were identified and eligible for inclusion. Random-effects models were used to calculate pooled Odds Ratios (ORs) and 95% Confidence Intervals (CIs) while heterogeneity was assessed by the I-squared statistics. Results: 30-day mortality (OR 0.81, 95% CI 0.47-1.42) and one-year mortality (OR 0.91, 95% CI 0.71-1.17) did not differ between groups. However, the numbers of 30 day stroke were nonsignificantly higher in the bicuspid anatomy group (OR 1.16, 95% CI 0.78-1.72). Permanent pacemaker implantation was similar (OR 1.05, 95% CI 0.91-1.21). There was not much difference observed anywhere. Conclusion: Neither mortality nor pacemaker results between TAVR for bicuspid and tricuspid aortic anatomy in the low surgical risk population showed significant differences; however, there was a small early cerebrovascular signal that suggests TAVR is feasible in a targeted patient population with bicuspid aortic anatomy, and further adequately powered randomized evidence is warranted.

Keywords: Transcatheter aortic valve replacement, Bicuspid aortic valve, Aortic stenosis, Low surgical risk, Stroke