Transcatheter Aortic Valve Replacement in Bicuspid Aortic Valve Stenosis

Flavien Vincent, MD, PhD; Julien Ternacle, MD, PhD*; Tom Denimal, MD; Mylène Shen, MSc; Bjorn Redfors, MD, PhD; Cédric Delhaye, MD; Matheus Simonato, MD; Nicolas Debry, MD; Basile Verdier, MD; Bahira Shahim, MD, PhD; Thibault Pamart, MD; Hugues Spillemaeker, MD; Guillaume Schurtz, MD; François Pontana, MD, PhD; Vinod H. Thourani, MD; Philippe Pibarot, DVM, PhD; Eric Van Belle, MD, PhD


Circulation. 2021;143(10):1043-1061. 

In This Article


We have seen from large RCTs that short- and long-term outcomes of TAVR were similar or superior to those of surgery in TAV patients. Despite the absence of controlled studies comparing surgery with TAVR in BAV patients, there are several observational studies showing comparable outcomes of TAVR in BAV and TAV AS. However, we should avoid invalid syllogistic reasoning and conclude that TAVR is similar to SAVR in BAV AS patients. Many uncertainties remain in the indications of TAVR in the absence of RCTs or longer-term follow-up. Further trials are needed to define the anatomic features of BAV that are the most suitable for TAVR as well as the optimal sizing technique and best implantation techniques. Surgery remains the first-line treatment for the vast majority of BAV patients. Nevertheless, TAVR using the latest THV prostheses may be a safe and reasonable alternative in patients with increased risk for surgery after a meticulous imaging evaluation of the AV anatomy.