Transcatheter aortic valve implantation in patients with bicuspid valve morphology: a roadmap towards standardization

Nat Rev Cardiol. 2023 Jan;20(1):52-67. doi: 10.1038/s41569-022-00734-5. Epub 2022 Jun 20.


Indications for transcatheter aortic valve implantation (TAVI) have expanded in many countries to include patients with aortic stenosis who are at low surgical risk, and a similar expansion to this cohort is anticipated elsewhere in the world, together with an increase in the proportion of patients with bicuspid aortic valve (BAV) morphology as the age of the patients being treated decreases. To date, patients with BAV have been excluded from major randomized trials of TAVI owing to anatomical considerations. As a consequence, BAV has been a relative contraindication to the use of TAVI in international guidelines. Although clinical experience and observational data are accumulating, BAV presents numerous anatomical challenges for successful TAVI, despite advances in device design. Furthermore, in those with BAV, substantial geographical variation exists in patient characteristics, clinical approach and procedural strategy. Therefore, in this Roadmap article, we summarize the existing evidence and provide consensus recommendations from an international group of experts on the application of TAVI in patients with BAV in advance of the anticipated growth in the use of this procedure in this challenging cohort of patients.

Publication types

  • Review
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aortic Valve / diagnostic imaging
  • Aortic Valve / surgery
  • Aortic Valve Stenosis* / surgery
  • Bicuspid Aortic Valve Disease* / etiology
  • Bicuspid Aortic Valve Disease* / surgery
  • Heart Valve Diseases* / etiology
  • Heart Valve Diseases* / surgery
  • Humans
  • Mitral Valve
  • Reference Standards
  • Transcatheter Aortic Valve Replacement*
  • Treatment Outcome