Surgical vs Transcatheter Aortic Valve Replacement in Bicuspid Valve Stenosis: A Time-To-Event M

Journal of the American Heart Association, Volume 15, Issue 6 , March 17, 2026. BackgroundThe role of transcatheter aortic valve implantation (TAVI) in bicuspid aortic valve stenosis requires further evaluation, particularly as its use has become comparable to surgical aortic valve replacement.

We sought to compare midterm outcomes of TAVI and surgical aortic valve replacement in patients with bicuspid aortic valve stenosis.MethodsSystematic searches of MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials identified studies reporting TAVI and surgical aortic valve replacement outcomes in patients aged ≥60 years with bicuspid aortic valve stenosis. The primary analysis included only comparative studies with interpretable Kaplan–Meier curves.

Individual patient data were reconstructed for time‐to‐event analysis. Sensitivity analyses incorporated noncomparative single‐arm studies.

Baseline differences and heterogeneity were addressed using landmark analysis, time‐varying hazard ratios (HRs), frailty Cox models, and covariate‐adjusted restricted mean survival time. The primary outcome was death with or without unplanned rehospitalization and stroke.ResultsFive comparative, risk‐adjusted studies (TAVI, 5901; surgical aortic valve replacement, 12 427) were included.