Proceed with caution: addressing the evidence gap and patient bias in transcatheter aortic valve replacement for bicuspid aortic stenosis

With the comparative evidence between transcatheter aortic valve replacement (TAVR) and surgical aortic valve replacement (SA-VR) now being well-established, TAVR has become an effective alternative to surgery in all risk spectra.In recent years, TAVR has been increasingly adopted, with its procedural volume surpassing that of SAVR and is being performed in progressively younger patients. [1]As the age of patients undergoing TAVR decreases, the proportion of those with bicuspid aortic valve (BAV) anatomy is likely to rise.The applications of TAVR have also expanded to BAV patients, [2] but the condition often involves complex anatomical challenges such as heavy leaflet calcification and aortopathy.Although the current recommendations for TA-VR in BAV patients remain prudent in the major guidelines, [3] current widespread adoption of TAVR in BAV patients is of concern.