Transcatheter aortic valve implantation in bicuspid aortic valves: present and future

The prevalence of bicuspid aortic valves (BAV) in patients undergoing transcatheter aortic valve implantation (TAVI) is expected to gradually increase over the coming years. However, in the absence of dedicated randomized trials, TAVI outcomes in BAV patients have failed to match those obtained in trileaflet anatomies. This discrepancy is mainly due to varying degrees of valve morphology and calcification, aortic angulation, concomitant aortopathy, and the difficulties of achieving optimal preprocedural anatomic sizing and device selection in the BAV setting. In this review, we aim to outline the current state of knowledge in the BAV and TAVI field, evaluate the main challenges faced by TAVI operators when dealing with these anatomies, summarize novel approaches for sizing and preprocedural evaluation, and provide a glimpse into the future of this interesting and evolving field.