In patients with tricuspid aortic valve stenosis, the coexistence of aortic regurgitation (AR) at baseline has been associated with improved outcomes following transcatheter aortic valve implantation (TAVI). However, its prognostic impact in patients with bicuspid aortic valve (BAV) stenosis remains unknown.

We enrolled consecutive patients with severe Sievers type 1 BAV stenosis undergoing TAVI at 24 international centers. Patients were stratified into 2 groups according to baseline AR severity: pure BAV stenosis (ie, no or mild AR) and mixed BAV disease (ie, moderate or severe AR). Clinical outcomes were compared using adjusted Cox models. The primary endpoint was major adverse events (MAE), defined as a composite of all-cause death, cerebrovascular events, or hospitalization for heart failure.

A total of 956 patients were included, of whom 134 (14%) had mixed BAV disease and 822 (86%) had pure BAV stenosis. At a median follow-up of 1.2 [0.4-2.2] years, patients with mixed BAV disease had a lower risk of MAE compared with those with pure BAV stenosis (9.0% vs 17.5%; adjusted hazard ratio [HRadj], 0.47; 95%CI, 0.25-0.85; P=.013), mainly driven by a significantly lower risk of all-cause death (6.0% vs 12.0%; HRadj, 0.44; 95%CI, 0.21-0.92; P=.029).

Among patients with Sievers type 1 BAV stenosis undergoing TAVI, those with mixed BAV disease had a lower risk of MAE than those with pure BAV stenosis.