Key result
Contemporary studies indicate that short- and mid-term outcomes of transcatheter aortic valve implantation with new generation prostheses are similar in patients with bicuspid and tricuspid valves.
Why the study?
BAV stenosis was traditionally considered a contraindication to TAVI and excluded from clinical trials, but indications are expanding to younger patients where BAV is more prevalent.
Does transcatheter aortic valve implantation (TAVI) provide safe and effective outcomes in patients with bicuspid aortic valve stenosis compared to tricuspid aortic valve stenosis?
Does transcatheter aortic valve implantation (TAVI) provide safe and effective outcomes in patients with bicuspid aortic valve stenosis compared to tricuspid aortic valve stenosis?
TAVI is increasingly recognized as a feasible and effective treatment for bicuspid aortic valve stenosis, with outcomes comparable to those in tricuspid aortic valve stenosis.
May support TAVI consideration in bicuspid valves; leaves open need for randomized long-term confirmation.
Bicuspid aortic valve (BAV) stenosis has traditionally been perceived as a contraindication to transcatheter aortic valve implantation (TAVI) due to its specific anatomical characteristics including extensive calcifications, high leaflet coaptation and frequently encountered aortic root dilation, which may result in worse procedural outcomes and higher risk of complications. Hence, BAV patients were not included in previous clinical trials. In the recent years, improved pre-procedural imaging and technological advances have gradually enabled expansion of TAVI to patients with complex anatomy, including those with BAV. Moreover, indications for TAVI are expanding to a younger group of patients with fewer comorbidities, and BAV is more prevalent in this population. Contemporary multicenter registry-based studies indicate that patients undergoing TAVI for BAV have similar outcomes as those with tricuspid aortic valve stenosis. In this article, we provide a thorough overview of the available clinical data regarding the outcomes of TAVI in BAV, from the perspective of an experienced TAVI center with over 150 TAVIs in this group of patients, performed in our institution since the year 2009. We present anatomical and clinical classifications of BAV, differences in outcomes in patients with bicuspid and tricuspid valves, as well as important topics regarding choice of an adequate valve and valve size.
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Walczewski et al. (2021) conducted a review in Bicuspid aortic valve stenosis. Transcatheter aortic valve implantation (TAVI) vs. TAVI in tricuspid aortic valve (TAV) was evaluated. Contemporary studies indicate that short- and mid-term outcomes of transcatheter aortic valve implantation with new generation prostheses are similar in patients with bicuspid and tricuspid valves.
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