Transcatheter aortic valve implantation in bicuspid aortic valve regurgitation: a case report

Transcatheter aortic valve implantation (TAVI) for pure aortic regurgitation (AR) remains challenging, especially in bicuspid aortic valve (BAV) anatomy, which has been excluded from pivotal trials of dedicated AR devices. Whether cusp-engaging devices can be used in type 1 BAV with raphe is unknown. We report two East Asian male patients (aged 72 and 62 years) with severe pure AR and type 1 bicuspid aortic valve, confirmed by transthoracic echocardiography. Pre-procedural multidetector computed tomography (MDCT) demonstrated a raphe between the left and right coronary cusps in both patients, with relatively symmetric cusp sizes and minimal calcification. Self-expanding Taurus-Trio valves (27 mm and 25 mm, respectively) were successfully implanted under monitored anaesthesia care (MAC) with TTE guidance. Post-procedural TTE showed only trivial paravalvular leak (PVL). At 6-month follow-up, MDCT confirmed favourable valve performance, with all three locators appropriately engaged within the corresponding cusps, preserved leaflet morphology and motion, and no evidence of hypo-attenuated leaflet thickening (HALT). Neither patient developed new conduction disturbances requiring permanent pacemaker implantation. This case report demonstrates the feasibility of using a dedicated cusp-engaging transcatheter valve in carefully selected patients with type 1 BAV-AR, favourable cusp symmetry, and minimal calcification. These findings are hypothesis-generating and warrant further investigation; they should not be generalised to all BAV subtypes or to patients with significant calcification.