Transcatheter Aortic Valve Replacement for Severe Bicuspid Aortic Valve Stenosis

Surgical aortic valve (AV) replacement has been the standard treatment for patients with severe symptomatic degenerative AV stenosis (AS). In recent years, transcatheter AV replacement has emerged as an established alternative in selected patient populations, supported by robust evidence in tricuspid AS. However, there has been limited evaluation of transcatheter AV replacement in bicuspid AV AS. Recently, several observational studies have demonstrated the feasibility and safety of transcatheter AV replacement in bicuspid AV AS, and the use of newer-generation devices has shown encouraging outcomes. However, the incidence of procedural complications such as paravalvular regurgitation, permanent pacemaker implantation, and aortic root injury was more frequent in patients with bicuspid AV AS compared with tricuspid AS. We review the clinical evidence of transcatheter AV replacement for bicuspid AV AS and suggest the appropriate criteria for patient and device selection, implantation techniques, and further management.