INVASIVE INTERVENTIONS IN STRUCTURAL HEART DISEASES: COMPREHENSIVE TECHNIQUES

Invasive Interventions in Structural Heart Diseases-kapak

TAVI IN BICUSPID AORTIC VALVES

Levent Pay

İstanbul Haseki Training and Research Hospital, Department of Cardiology, İstanbul, Türkiye

Pay L. Tavi in Bicuspid Aortic Valves. In: Tanık VO, Özlek B, editors. Invasive Interventions in Structural Heart Diseases: Comprehensive Techniques. 1st ed. Ankara: Türkiye Klinikleri; 2025. p.315-327.

ABSTRACT

Transcatheter aortic valve implantation (TAVI) has gained broad acceptance as a therapeutic option for aortic stenosis (AS), especially among high-risk and elderly patients. However, bicuspid aortic valve (BAV), the most common congenital heart disease was historically excluded from randomized clinical studise due to anatomical challenges and higher complication rates, such as paravalvular leak (PVL), annular rupture, and permanent pacemaker implantation.

Recent advancements in TAVI technology and procedural planning have improved outcomes, making TAVI a viable option for select BAV patients. Proper preprocedural assessment, including detailed CT imaging, is crucial to evaluate valve morphology, calcification distribution, and aortic root dimensions. Challenges in BAV-TAVI include increased calcium burden, elliptical annulus shape, and associated aortopathy, which may lead to procedural complications. While newer-generation TAVI devices have reduced PVL and mortality rates, BAV patients still exhibit an increased likelihood of stroke, annulus rupture, and pacemaker implantation compared to tricuspid AS patients.

Patient selection remains critical, and surgery is preferred for younger, low-risk individuals and those presenting with aortic root dilation or complex coronary artery disease. Nevertheless, TAVI may be a viable alternative for older, high-risk patients with bicuspid aortic valve disease, provided there is no severe calcification and no requirement for additional surgical intervention. Long-term durability data for TAVI in BAV are still limited, warranting further research.

Keywords: Aortic valve stenosis; Bicuspid aortic valve disease; Interventional cardiology; transcatheter aortic valve implantation; Long-term outcomes; Clinical trials

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