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.
Keywords: AV, aortic valve; BAV, bicuspid aortic valve; BEV, balloon-expandable valve; MDCT, multidetector computed tomography; ODP, optimal deployment projection; PVL, paravalvular leak; SEV, self-expanding valve; TAV, tricuspid aortic valve; TAVR, transcatheter aortic valve replacement; THV, transcatheter heart valve; aortic stenosis; balloon-expandable valve; bicuspid aortic valve; transcatheter aortic valve replacement; transcatheter heart valve.
© 2021 The Authors.