TAVI in Bicuspid Aortic Valve Stenosis: Cautiously Feasible

Bicuspid aortic valve (BAV) disease is the most common congenital cardiac malformation with a prevalence of 0.4% to 2%. For a long time, a BAV has not been considered an indication for transcatheter aortic valve implantation (TAVI) due to insufficient technology and poor procedural results conferred by a challenging valvular anatomy leading to poor stability of the prosthetic valve and/or paravalvular regurgitation due to distorted native valve leaflets. Large randomized controlled TAVI trials typically excluded bicuspid aortic stenosis (AS) because of its unique anatomic features. However, current technological advancements are apparently changing this landscape, and over the last few years, TAVI appears technically feasible, albeit a demanding procedure, and has been used to treat severe bicuspid AoV stenosis with promising results, as shown, apart from earlier case reports and patient series, in several recent observational studies and comparative trials between patients with tricuspid and patients with BAV. Thus, current literature cautiously supports a role of TAVI in selected BAV AS patients; however, the final role of this technique in this challenging group of patients will need to be determined from randomized controlled trials comparing TAVI with surgical replacement and studies comparing TAVI in bicuspid and tricuspid aortic valves. Technological advancements appear to play a significant and crucial role in rendering the transcatheter approach feasible, efficacious and safe. Rhythmos 2017;12(3): 40-44