Successful transcatheter aortic valve replacement in an oversized 800 mm2 annulus and bicuspid aortic valve

Abstract

The current iterations of balloon-expandable transcatheter aortic valve replacement (TAVR) valves consist of a maximum size of 29 mm, corresponding to maximum annulus area of 680 mm². However, a number of patients who qualify for TAVR based on surgical risk may have anatomical features outside the FDA-approved descriptions. The technique of overexpansion of TAVR valves during deployment allows for more patients to be treated successfully. This particular case demonstrates that overexpansion is safe and efficacious in a very large annulus of >800 mm². Careful planning and consideration of aortic root calcification is helpful for technique of overexpansion and, ultimately, the technique may increase the number of patients eligible for TAVR.

Keywords: Annulus; Aortic stenosis; Bicuspid aortic valves; Surgical aortic valve replacement; Transcatheter aortic valve replacement.