Transcatheter aortic valve replacement in bicuspid aortic valve disease

Bicuspid aortic valve stenosis is regarded as a relative contraindication for transcatheter aortic valve replacement (TAVR) according to current guidelines, as patients with bicuspid anatomy (BiAV) were excluded from landmark clinical trials.In this review, we will discuss the feasibilty, safety and outcomes of TAVR in BiAV, based upon the current literature and our own experience.

The currently available data come from observational registries with low sample size, and only in a few were the results of TAVR in BiAV compared with those achieved in the cohort with tricuspid anatomy. TAVR proved to be technically feasible in selected BiAV patients, and the mid-term clinical outcomes are acceptable. Nevertheless, there are still some unresolved issues, such as long-term valve durability and the relatively high rate of paravalvular leakage.

The existing literature supports the use of TAVR in selected high-risk BiAV patients, although the final role of this technique in this cohort of patients can only be established once a larger, preferably randomized, study comparing TAVR with surgery is performed.