Application of Balloon-Expandable Transcatheter Heart Valve in Bicuspid Aortic Valve

• Published in: JACC. Asia Vol. 1; no. 2; pp. 147 - 161
• Main Authors: Chen, Mi, Michel, Jonathan, Kasel, Albert Markus
• Format: Journal Article
• Language: English
• Published: Elsevier Inc 01.09.2021; Elsevier
• Subjects: aortic stenosis; balloon-expandable valve; bicuspid aortic valve; transcatheter aortic valve replacement; transcatheter heart valve; THV; SEV; PVL; TAV; transcatheter heart valve; balloon-expandable valve; MDCT; TAVR; BEV; aortic stenosis; bicuspid aortic valve; AV; BAV; transcatheter aortic valve replacement; ODP
• ISSN: 2772-3747; 2772-3747
• DOI: 10.1016/j.jacasi.2021.07.012

Bicuspid aortic valve (BAV) remains challenging in transcatheter aortic valve replacement (TAVR) because of unfavorable anatomy. New-generation balloon-expandable valve (BEV) appears to be a valid alternative to surgery, especially in some Asian countries with a higher prevalence of BAV. This tutorial review summarizes current thinking about how to plan and implant BEV in BAVs using versatile techniques. First, the authors depict the main morphological characteristics of BAVs and their effects on the TAVR procedure. Next, the authors provide preprocedural analysis on sizing, obtaining the optimal deployment projection, and how to simplify valve-crossing. Finally, the authors provide step-by-step guidance on how to deploy the BEVs with evolved iterations in terms of specific anatomies, calcified annulus, and giant annulus. [Display omitted] •There is growing concern to treat BAV patients in TAVR procedures.•Versatile BEV shows high performance in all types of BAV.•Anatomy-based analysis and procedural iteration enable BEV’s feasibility and safety in BAV.•Tailored THV and techniques might achieve a comparable result when compared with TAV.