Redo-TAVI feasibility and coronary accessibility following index TAVI with the Evolut valve in patients with bicuspid aortic valve stenosis

With an increasing choice of transcatheter aortic valve implantation (TAVI) to treat younger aortic valve stenosis (AS) patients, it can be anticipated that (1) TAVI will be used more often to treat bicuspid AS, as the latter is more often encountered in young patients, and (2) there will be an increasing need for redo-TAVI in the future. In general, there is more limited evidence on the performance of TAVI in bicuspid AS, as this has been kept out of the large randomised trials. Still, there are relatively good registry data on the safety and efficacy of TAVI with the balloon-expandable SAPIEN (Edwards Lifesciences) and self-expanding Evolut (Medtronic) transcatheter aortic valves (TAVs) to treat severe bicuspid AS12. Unfortunately, there are no data available on redo-TAVI feasibility in patients with bicuspid AS. Redo-TAVI in the self-expanding Evolut can present challenges because of the supra-annular leaflet position, which may result in a higher functional neoskirt in case of redo-TAVI. This study aimed to assess redo-TAVI feasibility and coronary accessibility following index TAVI with an Evolut TAV in patients with bicuspid AS...