Bicuspid aortic valves and TAVI: Is it still an exclusion criterion? State of the art and open issues

Bicuspid aortic valve (BAV) is the most common congenital valvular disease, and is found in approximately 22% of all patients presenting with symptomatic severe aortic stenosis who are deemed high-risk for surgery. While BAV has historically been considered a relative contraindication to transcatheter aortic valve implantation, technical improvements in addition to greater operator confidence and experience has resulted in an increased number of percutaneous valve implantations in this patient group. Areas of uncertainty remain, but data from the literature suggests that the procedure can be safely performed in the setting of BAV, with results comparable to tricuspid aortic valve patients, at the expense of higher rates of short-term complications and postprocedural aortic regurgitation.