Key result
Transfemoral TAVI succeeds in challenging bicuspid anatomy with extreme horizontal aortic angulation.
Why the study?
Transfemoral TAVI in bicuspid aortic valves with extreme horizontal aorta to left ventricle angulation presents technical challenges and is often considered contraindicated.
Case Report (n=2)
Supports feasibility of TAVI in bicuspid valves with extreme Ao-LV angulation; leaves open optimal device selection and durability.
Transcatheter aortic valve implantation (TAVI) has become one of the standard care of therapy for aortic stenosis. The indications for TAVI are rapidly expanding, but there are many technical challenges faced during the procedure, like anatomical variation, vascular access and severe calcification. We hereby report two anatomically challenging cases of TAVI in bicuspid aortic valves with extreme horizontal aorta to left ventricle angle (Ao-LV) treated with two different types of valves. Though horizontal aorta having an angle more than 70° is considered as contraindication for transfemoral TAVI, with development of newer devices that have more flexible delivery system, smaller size and steerable systems, TAVI can be successfully performed using transfemoral approach.
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Gunasekaran et al. (2018) conducted a case report in Aortic stenosis with bicuspid aortic valve and extreme horizontal aorta to left ventricle angle (n=2). Transfemoral transcatheter aortic valve implantation (TAVI) was evaluated on Procedural success. Transfemoral TAVI was successfully performed in two anatomically challenging cases of bicuspid aortic valves with extreme horizontal aorta to left ventricle angle using newer devices.
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