Cardiovascular Events
The median follow-up duration was 3.2 years (IQR 2.2-4.8) and similar in both groups. During follow-up there were 80 (39.6%) primary events (all-cause mortality, n=41; AVR, n= 24, TAVR, n=11, Ross procedure=1 and Bentall and De Bono procedure= 3) with no significant differences in terms of occurrence of the composite primary end-point between both groups (34.8 vs. 40.8%; p=0.2). Overall estimated all-cause mortality and intervention-free survival was 59±4% in TAV patients vs. 65± 7% in BAV patients at 5 years (log rank test p = 0.24), Figure 1. However, in patients with BAV, most of the events were at the expense of aortic valve intervention (39% of BAV group required aortic valve intervention during follow-up vs 13.8% in TAV group, p = 0.0004), as seen in Figure 2. Patients with BAV were younger (58.2 ± 8.8 vs 78.7 ± 7.4, p<0.0001) and had higher maximum aortic transvalvular velocity (4.4± 0.4 vs 3.6 ± 0.5, p=0.03) and higher mean gradient (47.8 ± 8.8 vs 33.1 ± 6.1, p=0.05) at the time of developing symptoms and requiring valve intervention.
The incidence of CV death did not present significant differences between both groups (4.8% vs. 12%, p=0.25). Although the TAV group had a trend towards higher CV mortality, 5 of these deaths occurred in patients with an indication for an intervention that was not carried out (due to high frailty, dementia or patient refusal). Lastly, 16.3% of the TAV group died of non-CV causes vs none in the VAB group, which translates into higher overall mortality (p = 0.001).
Type of aortic valve intervention is shown in Figure 3. TAVR was more frequent in TAV group (p=0.01) and correction of valve and ascending aortic disease (Bentall and De Bono and Ross procedures) were more frequent in BAV patients (p=0.03).
Vmax and dimensionless index were independently associated with primary end point occurrence during follow-up in both groups. Age and coronary heart disease were significantly associated with a higher incidence of the primary end-point at follow-up (p <0.001) in TAV group, whereas in BAV group mean gradient was significantly associated with a higher incidence of the primary end-point (p <0.001).