{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T06:51:59Z","timestamp":1787813519369,"version":"build-2784847793"},"reference-count":38,"publisher":"BMJ","issue":"1","license":[{"start":{"date-parts":[[2025,6,13]],"date-time":"2025-06-13T00:00:00Z","timestamp":1749772800000},"content-version":"unspecified","delay-in-days":163,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"Zhejiang Province Science and Technology Innovation Leading Talents Project","award":["2023R5236"],"award-info":[{"award-number":["2023R5236"]}]},{"name":"State Key Laboratory of Transvascular Implantation Devices","award":["N\/A"],"award-info":[{"award-number":["N\/A"]}]},{"name":"Zhejiang Province Science and Technology Department Key R&D Program","award":["2018C03084"],"award-info":[{"award-number":["2018C03084"]}]},{"name":"Zhejiang Province Science and Technology Department Key R&D Program","award":["2021C03097"],"award-info":[{"award-number":["2021C03097"]}]},{"name":"Zhejiang Province Science and Technology Department Key R&D Program","award":["2022C03063"],"award-info":[{"award-number":["2022C03063"]}]},{"name":"Zhejiang Province Science and Technology Department Key R&D Program","award":["2024C03024"],"award-info":[{"award-number":["2024C03024"]}]},{"name":"Natural Science Foundation of Zhejiang Province of China","award":["LQ21H020005"],"award-info":[{"award-number":["LQ21H020005"]}]},{"name":"The grants from The Key R & D projects of Zhejiang Province","award":["2024C03024"],"award-info":[{"award-number":["2024C03024"]}]},{"name":"Healthy Zhejiang One Million People Cohort","award":["K-20230085"],"award-info":[{"award-number":["K-20230085"]}]},{"name":"Zhejiang Research Center of Cardiovascular Diagnosis and Treatment Technology","award":["JBZX-202001"],"award-info":[{"award-number":["JBZX-202001"]}]},{"DOI":"10.13039\/501100001809","name":"The National Natural Science Foundation of China","doi-asserted-by":"crossref","award":["82200406"],"award-info":[{"award-number":["82200406"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/501100001809","name":"The National Natural Science Foundation of China","doi-asserted-by":"crossref","award":["82271606"],"award-info":[{"award-number":["82271606"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/501100001809","name":"The National Natural Science Foundation of China","doi-asserted-by":"crossref","award":["82425007"],"award-info":[{"award-number":["82425007"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"crossref"}]},{"name":"Key R&D Program of China","award":["2019YFA0110400"],"award-info":[{"award-number":["2019YFA0110400"]}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Open Heart"],"accepted":{"date-parts":[[2025,5,14]]},"published-print":{"date-parts":[[2025,1]]},"abstract":"<jats:sec>\n                  <jats:title>Objective<\/jats:title>\n                  <jats:p>To compare the clinical outcomes and haemodynamic performance following transcatheter aortic valve replacement (TAVR) in patients with severe bicuspid versus tricuspid aortic stenosis (AS) and small annuli.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Design<\/jats:title>\n                  <jats:p>Retrospective analysis based on a prospective observational cohort.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Setting<\/jats:title>\n                  <jats:p>Single-centre registry of patients undergoing TAVR between 2016 and 2023.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Participants<\/jats:title>\n                  <jats:p>A total of 427 patients (193 bicuspid (BAV) and 234 tricuspid (TAV) aortic valve) with symptomatic severe AS and small annuli (median area 381.5 mm<jats:sup>2<\/jats:sup> (IQR 348.0\u2013406.4)), all undergoing preprocedural multidetector CT and standardised follow-up echocardiography.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Main outcomes measure<\/jats:title>\n                  <jats:p>Baseline characteristics, technical success, procedural complications, haemodynamic performance and bioprosthetic-valve dysfunction (BVD) were compared between groups. The primary clinical outcome was major adverse cardiac and cerebrovascular events (MACCE), a composite of all-cause mortality, stroke and rehospitalisation for heart failure.<\/jats:p>\n                  <jats:p>Cox regression was used to adjust for confounders.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Compared with TAV patients, BAV recipients experienced higher technical failure rates (11.4% vs 6.0%, p=0.045) but lower permanent pacemaker implantation (4.7% vs 12%, p=0.008) at discharge. The 1-year MACCE rate was similar between groups (14.5% vs 9.8%, log-rank p=0.719), and Cox regression analyses adjusting for confounders revealed no significant difference (HR 1.408 (95% CI 0.622 to 3.191), p=0.412). Both groups demonstrated significant improvements in valve haemodynamics, with comparable rates of BVD (11.4% vs 9.2%, p=0.502) and structural valve dysfunction. Multivariate analysis demonstrated equivalent long-term survivals (HR 0.950 (95% CI 0.526 to 1.714), p=0.864) between groups.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>TAVR provides comparable clinical and haemodynamic outcomes for bicuspid and tricuspid AS with a small aortic annulus, despite greater procedural complexity in BAV cases. These findings support cautious expansion of TAVR to select BAV patients when performed with meticulous procedural planning.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/openhrt-2025-003357","type":"journal-article","created":{"date-parts":[[2025,6,13]],"date-time":"2025-06-13T07:05:29Z","timestamp":1749798329000},"page":"e003357","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":2,"title":["Transcatheter bicuspid versus tricuspid aortic valve replacement in patients with a small aortic annulus: an observational study"],"prefix":"10.1136","volume":"12","clinical-trial-number":[{"clinical-trial-number":"nct04722796","registry":"10.18810\/clinical-trials-gov"}],"author":[{"ORCID":"https:\/\/orcid.org\/0009-0006-6958-4640","authenticated-orcid":false,"given":"Wenjing","family":"Sheng","sequence":"first","affiliation":[{"name":"Department of Cardiology, The Second Affiliated Hospital Zhejiang University School of Medicine, 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Hangzhou, Zhejiang, China"},{"name":"State Key Laboratory of Transvascular Implantation Devices, Hangzhou, Zhejiang, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chongzhou","family":"Zheng","sequence":"additional","affiliation":[{"name":"Department of Cardiology, The Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, Zhejiang, China"},{"name":"State Key Laboratory of Transvascular Implantation Devices, Hangzhou, Zhejiang, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dao","family":"Zhou","sequence":"additional","affiliation":[{"name":"Department of Cardiology, The Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, Zhejiang, China"},{"name":"Medicine, Zhejiang University, Hangzhou, Zhejiang, China"},{"name":"State Key Laboratory of Transvascular Implantation Devices, Hangzhou, Zhejiang, 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