Bicuspid aortic valve (BAV) is a congenital heart defect where the aortic valve has only two cusps instead of the three that are typical in tricuspid aortic valves (TAVs).

BAVs are present in approximately 1-2% of the population and often lead to aortic valve stenosis (AS) earlier in life than patients with TAVs.

When transcatheter aortic valve replacement (TAVR) entered the treatment space for AS, BAV was initially listed as a contraindication to TAVR.

This was a result of the potential complications that could arise from having an atypical aortic valve.

However, this has been challenged by several clinical trials that have indicated favourable results for TAVR treatment in BAV patients.

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As a result of these positive results, TAVR was increasingly implemented in BAV patients via off-label usage, bolstering a growth rate of 41% between 2015 and 2020 in BAV stenosis treatment.

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In 2021, TAVR for low-risk patients regardless of aortic valve anatomy received both US Food and Drug Administration (FDA) and CE mark approval.

Despite receiving regulatory approval, international guidelines still recommend open surgical replacement in BAV populations.

According to interventional cardiologists, TAVR is currently reserved for high-risk surgical BAV patients while open surgical valve replacement remains the main treatment option for low-risk surgical BAV patients.

TAVR treatment in BAV patients still remains relatively low in comparison to TAVR treatment in TAV patients.

Continued research and innovation are needed to fully realise the potential of TAVR in BAV patients and to ensure optimal long-term outcomes.