Excellent In-Hospital Outcomes in Bicuspid TAVI. But What Comes Next?

Transcatheter aortic valve implantation (TAVI) has expanded rapidly over the last decade, driven by randomized trials, contemporary registries, and the progressive evolution of international guideline recommendations. In parallel, multicenter studies have increasingly demonstrated the use of TAVI in more complex and lower surgical risk populations, including patients with bicuspid anatomy. As accumulated experience increased and newer generations of transcatheter valves were incorporated into clinical practice, scenarios previously considered challenging began to be explored more frequently, including aortic stenosis associated with a bicuspid aortic valve.

However, questions remain regarding the extent to which evidence derived from tricuspid aortic stenosis can be directly extrapolated to patients with bicuspid anatomy. As highlighted by Hirji et al., bicuspid valve disease represents a fundamentally distinct condition from degenerative tricuspid stenosis, characterized by asymmetric calcification, elliptical annular geometry, and a high prevalence of associated aortopathy. These characteristics introduce challenges capable of affecting both immediate procedural success and long-term valve performance and durability.

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