Bicuspid Aortic Valve Disease: Classifications, Treatments, and Emerging Transcatheter Paradigms

• Published in: Structural heart (Online) 2024-01, Vol.8 (1), p.100227, Article 100227
• Main Authors: Kalra, Ankur, Das, Rajiv, Alkhalil, Mohammad, Dykun, Iryna, Candreva, Alessandro, Jarral, Omar, Rehman, Syed M., Majmundar, Monil, Patel, Kunal N., Rodes-Cabau, Josep, Reardon, Michael J., Puri, Rishi
• Format: Article
• Language: English
• Subjects: Aortic stenosis; Bicuspid aortic valve; Review; Surgical aortic valve replacement; Transcatheter aortic valve replacement
• ISSN: 2474-8706; 2474-8714; 2474-8714
• DOI: 10.1016/j.shj.2023.100227

Bicuspid aortic valve (BAV) is a common congenital valvular malformation, which may lead to early aortic valve disease and bicuspid-associated aortopathy. A novel BAV classification system was recently proposed to coincide with transcatheter aortic valve replacement being increasingly considered in younger patients with symptomatic BAV, with good clinical results, yet without randomized trial evidence. Procedural technique, along with clinical outcomes, have considerably improved in BAV patients compared with tricuspid aortic stenosis patients undergoing transcatheter aortic valve replacement. The present review summarizes the novel BAV classification systems and examines contemporary surgical and transcatheter approaches. •Indications for surgical intervention in patients with bicuspid aortic valve (BAV) mirror the same for transcatheter aortic valve (TAV).•The data for transcatheter aortic valve replacement (TAVR) in BAV patients using newer generation prostheses are encouraging.•Patients with BAV are younger with lower operative risk and longer life expectancy.•Newer BAV prostheses have improved sealing skirt designs reducing paravalvular leak rates.•Short-term survival rates for BAV TAVR are equivalent to TAVR for tricuspid valve AS.