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Updated: May 20, 2026
The Intra-Aortic Balloon Pump
Published on: February 5, 2021
Supra-Annular Transcatheter Aortic Valve Replacement Using Balloon-Expandable Valves in Bicuspid Anatomy With
Hossameldin Hussein1, Sudhakar George2, Adnan Nadir3
1Department of Cardiology, Queen Elizabeth University Hospital, Birmingham, United Kingdom; Department of Cardiology, Kasr Al-Ainy Medical School, Cairo University, Cairo, Egypt.
Background:
Transcatheter aortic valve replacement (TAVR) in patients with bicuspid aortic valves (BAVs) is challenging. Frequently, heavily calcified BAVs are also commonly associated with annuli exceeding sizing charts for commercial transcatheter heart valves. In many BAVs, supra-annular rather than conventional annular sealing may be feasible when the anatomy is tapered.
Case Summary:
We report 3 patients with BAV and very large annuli who underwent TAVR, in which successful outcomes were achieved using balloon-expandable valves (BEVs), with sealing and anchoring within the bicuspid leaflets rather than the annulus. In all cases, a transcatheter heart valve considerably smaller than the annulus was used successfully. Despite supra-annular positioning, coronary access was not compromised, and absence of migration was confirmed with interval multislice computed tomography.
Take-Home Messages:
Supra-annular TAVR can be successfully performed in patients with BAV and a very large annulus when the anatomy is tapered. Good anchoring and sealing can be achieved within the leaflets. Supra annular TAVR with short-framed BEVs may preserve coronary access better than taller framed self-expanding valves.