Overview
Bicuspid aortic stenosis occurs due to a congenital bicuspid aortic valve, leading to progressive narrowing and obstruction of the aortic outflow tract. This condition often necessitates intervention, including transcatheter aortic valve replacement (TAVR). 1Diagnosis
Echocardiography is essential for diagnosing bicuspid aortic valve and assessing severity of stenosis.
Computed tomography (CT) or magnetic resonance imaging (MRI) may be used to evaluate valve morphology and aortic root anatomy.
Grading of stenosis severity typically follows the American Heart Association guidelines, often using velocity criteria and valve area measurements. 1Management
First-line Treatment: Transcatheter aortic valve replacement (TAVR) is increasingly used, with choice between balloon-expandable valves (BEVs) and self-expanding valves (SEVs).
Valve Choice: BEVs may be preferred due to lower risk of permanent pacemaker implantation and moderate to severe paravalvular leakage compared to SEVs. 1
Surgical Aortic Valve Replacement (SAVR): Considered in cases where TAVR is contraindicated or less favorable outcomes are anticipated.
Medical Management: Focuses on symptom relief and management of comorbidities; includes anticoagulation, antihypertensives, and statins as needed. 1Special Populations
Elderly: TAVR is commonly used in elderly patients with bicuspid aortic stenosis due to higher surgical risks. 1
Comorbidities: Patients with comorbidities like renal impairment or lung disease require careful evaluation of TAVR risks and benefits; valve choice may influence outcomes. 1Key Recommendations
Consider Balloon-Expandable Valves (BEVs) in Bicuspid Aortic Stenosis: BEVs may offer advantages in reducing the need for permanent pacemaker implantation and paravalvular leakage compared to self-expanding valves. (Evidence: Moderate) 1
TAVR Should Be Evaluated as a Primary Intervention: For patients with symptomatic bicuspid aortic stenosis, especially in the elderly or those with high surgical risk, TAVR should be strongly considered. (Evidence: Moderate) 1
Individualized Risk Assessment is Crucial: Tailor valve choice and intervention strategy based on patient-specific factors including valve morphology, comorbidities, and anatomical considerations. (Evidence: Expert opinion) 1References
1 Attachaipanich T, Attachaipanich S, Kaewboot K. Balloon vs. self-expanding valves for transcatheter aortic valve implantation in bicuspid aortic stenosis: a meta-analysis. Journal of cardiovascular medicine (Hagerstown, Md.) 2025. link