Debate: Severe bicuspid aortic valve stenosis in non-high-risk surgical patients. In favor of TAVI

Abstract

QUESTION: What is the prevalence of bicuspid aortic valve (BAV) in your case series of transcatheter aortic valve implantation (TAVI) to this date? And what’s the patients’ surgical risk? ANSWER: Over 1000 TAVIs have already been performed at our center, and the prevalence of BAV stands at around 4.4%. It is greater compared to the Spanish TAVI registry where nearly 2% of the patients treated with TAVI have BAV.1 Thanks to the use of computed tomography scan as a systematic imaging modality to plan TAVI, its diagnosis has gone up. As a matter of fact, our group included the number of patients treated with TAVI or surgery in 2019 in 17 Spanish centers being the prevalence of BAV around 4.6%, and 16%, respectively. At times, the diagnosis of BAV is not an easy one, and when the heart valve is highly unstructured and calcified, it can go unnoticed. Therefore, it can be underdiagnosed in our series of TAVI. However, an «active» search can increase the number of diagnoses. In our series the risk profile of these patients is intermediate-high. The mean age is 80 years old with a similar distribution by sex. The risk scores measured were the logistic EuroSCORE (14.8%), the...