Transcatheter treatment of bicuspid aortic valve stenosis

Transcatheter aortic valve implantation (TAVI) has become an established treatment option for symptomatic patients suffering from aortic stenosis. A bicuspid aortic valve (BAV) is the most frequent congenital valvular abnormality. With the expansion of the indications for TAVI to patients at lower risk, including younger populations, a BAV is expected to be more frequently encountered. Several challenges are associated with BAVs, from diagnosis and classification to interventional or surgical treatment. Transcatheter prostheses, designed to treat tricuspid aortic valves, have shown promising results in BAV anatomies. However, technical limitations, such as underexpansion, ellipticity or procedural complications, have been identified. Several issues for transcatheter procedures are still a matter of discussion. In this state-of-the-art review, we explore the knowledge acquired about TAVI for BAVs, the sizing and technical specificities of interventional procedures, as well as the remaining evidence gaps and future perspectives.