TAVI for Bicuspid Aortic Valve: Addressing Technical Challenges and Optimizing Outcomes.

Area of Science:

• Cardiology
• Interventional Cardiology
• Congenital Heart Disease

Background:

• Bicuspid aortic valve (BAV) is the most common congenital heart defect, affecting 1-2% of the population.
• BAV predisposes individuals to premature aortic stenosis and thoracic aortopathy.
• Surgical aortic valve replacement (SAVR) is standard, but transcatheter aortic valve implantation (TAVI) is increasingly used.

Purpose of the Study:

• To review current knowledge on BAV anatomy and management.
• To explore the evidence for transcatheter approaches in BAV patients.
• To highlight challenges and strategies for TAVI in BAV.

Main Methods:

• Review of observational registries and early trial data.
• Analysis of device-success rates and complication rates.
• Emphasis on multimodality imaging and dedicated sizing algorithms.

Main Results:

• TAVI is technically feasible in selected BAV anatomies with >90% device success.
• BAV presents unique challenges, including higher rates of paravalvular leak and permanent pacemaker implantation.
• Annular complications are increased in cases with extensive calcifications or tapered roots.

Conclusions:

• TAVI is a viable option for BAV, but requires meticulous pre-procedural planning and device-specific strategies.
• Managing BAV with TAVI necessitates advanced imaging and tailored approaches.
• Long-term durability data are limited, necessitating further prospective trials.