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Review
. 2025 Apr 20;14(8):2838.
doi: 10.3390/jcm14082838.

Review Article: Contemporary Transcatheter Heart Valves for TAVI in Bicuspid Aortic Anatomy

Chrysavgi Simopoulou  1 , Omar Oliva  1 , Vincenzo Cesario  1 , Nicolas Dumonteil  1 , Didier Tchetche  1 , Chiara De Biase  1
Affiliations
Review

Review Article: Contemporary Transcatheter Heart Valves for TAVI in Bicuspid Aortic Anatomy

Chrysavgi Simopoulou et al. J Clin Med. .

Abstract

Bicuspid aortic valve (BAV) is the most common congenital heart disease, affecting 0.5-2% of the population and often leading to early aortic valve degeneration. While surgical aortic valve replacement (SAVR) remains the gold standard for treating severe bicuspid aortic stenosis (AS), transcatheter aortic valve implantation (TAVI) is emerging as a viable alternative in selected BAV anatomies. Initial experiences with first-generation transcatheter heart valves (THVs) showed the feasibility of this technique, but were associated with lower device success rates and higher complications, such as paravalvular leak (PVL) and pacemaker implantation. Advancements in second- and third- generation THVs, together with better pre-procedural imaging assessment and growing operator experience, have significantly enhanced TAVI outcomes in BAV patients, with results now comparable to those seen in tricuspid aortic valves (TAVs). Proper patient selection, pre-procedural sizing, and device implantation are key to improving TAVI success in BAV. Recent registry data on contemporary THV platforms demonstrate improved procedural success, hemodynamic performance, and the safety of TAVI in BAV. However, higher rates of PVL, pacemaker implantation, and strokes remain concerns. Ongoing advancements in THV design and procedural techniques will further enhance outcomes for this challenging population. Up to the present, there are no dedicated THVs for BAV, but the latest-generation THVs offer promising results.

Keywords: balloon-expandable valve (BEV); bicuspid aortic valve (BAV); paravalvular leak (PVL); permanent pacemaker implantation (PPI); self-expanding valve (SEV); transcatheter aortic valve implantation (TAVI).

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Morphological classification of the various types of bicuspid aortic valve anatomy.
Figure 2
Figure 2
Design and structural components of the different Transcatheter Heart Valve platforms. (A) Sapien 3, Edwards Lifesciences; (B) MyVal, Meril Life Sciences; (C) Evolut PRO, Medtronic; (D) Acurate Neo2, Boston Scientific; (E) Navitor system, Abbott. PET: Polyethylene Terephthalate.
See this image and copyright information in PMC

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