TAVR for Elderly Patient With Bicuspid Aortic Stenosis, Severe Horizontal Heart, and Ascending Aorta Dilation

Transcatheter aortic valve replacement (TAVR) has advanced from an emerging technology to a standard therapeutic option for high-risk patients with symptomatic severe aortic stenosis. Procedural risk correlates strongly with aortic root anatomy. In elderly patients with bicuspid aortic valves, concomitant horizontal cardiac orientation and ascending aortic dilation confer markedly higher procedural risk.

We report an elderly patient with a bicuspid aortic valve, severe horizontal aortic root angulation (88°), and ascending aortic dilation (approximately 60 mm). The presence of an ascending aortic aneurysm supported the indication for surgical intervention. Given the substantial technical complexity and perioperative risk of open-heart surgery, TAVR was selected as a safer alternative.

This case demonstrates that TAVR remains feasible in elderly patients with complex anatomy unsuitable for surgery, despite increased procedural challenges and risk.

In elderly patients with severe aortic stenosis and anatomically complex aortic pathology, TAVR should be considered a clinically viable treatment strategy.