The bicuspid aortic valve (BAV) represents a complex anatomic scenario for transcatheter aortic valve replacement (TAVR) because of its unique technical challenges. As TAVR is moving towards younger and lower-risk populations, the proportion of BAV patients undergoing TAVR is expected to rise. Initial experiences of TAVR with first-generation transcatheter heart valves in high surgical risk patients with BAV stenosis showed higher rates of device failure and periprocedural complications as compared to tricuspid anatomy. The subsequent advances in imaging techniques and understanding of BAV anatomy, new iterations of transcatheter heart valves, and growing operators’ experience yielded better outcomes. However, in the lack of randomized trials and rigorous evidence, the field of TAVR in BAV has been driven by empirical observations, with wide variability in transcatheter heart valve sizing and implantation techniques across different centers and operators. Thus, in this review article, we provide a fully illustrated overview of operative periprocedural steps for TAVR in BAV stenosis, though recognizing that it still remains anecdotal.

中文翻译：

---

经导管主动脉瓣置换术治疗二尖瓣主动脉瓣狭窄：实用手术概述

二叶式主动脉瓣 (BAV) 由于其独特的技术挑战，代表了经导管主动脉瓣置换术 (TAVR) 的复杂解剖场景。随着 TAVR 向年轻化和低风险人群发展，接受 TAVR 的 BAV 患者比例预计将上升。在患有 BAV 狭窄的高手术风险患者中使用第一代经导管心脏瓣膜进行 TAVR 的初步经验表明，与三尖瓣解剖相比，装置故障和围手术期并发症的发生率更高。随后成像技术的进步和对 BAV 解剖学的理解、经导管心脏瓣膜的新迭代以及不断增长的操作员经验产生了更好的结果。然而，由于缺乏随机试验和严格的证据，BAV 中的 TAVR 领域一直由经验观察驱动，不同中心和操作者的经导管心脏瓣膜尺寸和植入技术存在很大差异。因此，在这篇综述文章中，我们对 BAV 狭窄的 TAVR 围手术期步骤进行了全面的概述，尽管我们认识到这仍然是轶事。