Transcatheter aortic valve replacement for bicuspid aortic valve disease: does conventional surgery have a future?

• Type of Material: Article
• Authors: Breandan B Yeats, Georgia Institute of Technology; Pradeep K Yadav, Piedmont Heart Institute; Lakshmi Dasi, Emory University; Vinod Thourani, Emory University
• Language: English
• Date: 2022-07-01
• Publisher: AME PUBLISHING COMPANY
• Publication Version: Final Published Version
• Copyright Statement: 2022 Annals of Cardiothoracic Surgery. All rights reserved.
• License: Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.21037/acs-2022-bav-20
• Title of Journal or Parent Work: ANNALS OF CARDIOTHORACIC SURGERY
• Volume: 11
• Issue: 4
• Start Page: 389
• End Page: 401
• Grant/Funding Information: None.
• Keywords: LEAFLET THROMBOSIS; IMPACT; bicuspid aortic valve disease; CLASSIFICATION; surgical aortic valve replacement (SAVR); Life Sciences & Biomedicine; Cardiac & Cardiovascular Systems; DEPLOYMENT; EDWARDS-SAPIEN; IMPLANTATION; Surgery; Cardiovascular System & Cardiology; OUTCOMES; PARAVALVULAR REGURGITATION; DILATATION; BLOCK; Science & Technology; Transcatheter aortic valve replacement (TAVR)
• Research Categories: Engineering, Biomedical

Abstract

Bicuspid aortic valve (BAV) disease is the most common form of congenital heart valve defect. It is associated with aortic stenosis (AS), aortic insufficiency, and aortopathy. Treatment of severe AS requires valve replacement which historically has been performed with surgical aortic valve replacement (SAVR). Recently, transcatheter aortic valve replacement (TAVR) has emerged as a promising alternative. However, increased rates of adverse outcomes following TAVR have been shown in BAV patients with high amounts of calcification. Comparison between TAVR and SAVR in low surgical risk BAV patients in a randomized trial has not been performed and TAVR for BAV long-term performance is unknown due to lack of clinical data. Due to the complexity of BAV anatomies and the significant knowledge gap from the lack of clinical data, SAVR still has many benefits over TAVR in low surgical risk BAV patients. It also remains common for BAV patients to have an aortopathy, which currently can be treated with surgical techniques. This review aims to outline BAV associated diseases and their treatment strategies, the main TAVR adverse outcomes associated with anatomically complex BAV patients, TAVR strategies for mitigating these risks and the current state of cutting-edge 3D printing and computer modeling screening methods that can provide otherwise unobtainable preoperative information during the BAV patient selection process for TAVR.