A Bicuspid Aortic Valve Imaging Classification for the TAVR Era

Hasan Jilaihawi, Mao Chen, John Webb, Dominique Himbert, Carlos E. Ruiz, Josep Rodés-Cabau, Gregor Pache, Antonio Colombo, Georg Nickenig, Michael Lee, Corrado Tamburino, Horst Sievert, Yigal Abramowitz, Giuseppe Tarantini, Faisal Alqoofi, Tarun Chakravarty, Mohammad Kashif, Nobuyuki Takahashi, Yoshio Kazuno, Yoshio MaenoHiroyuki Kawamori, Alaide Chieffo, Philipp Blanke, Danny Dvir, Henrique Barbosa Ribeiro, Yuan Feng, Zhen Gang Zhao, Jan Malte Sinning, Chad Kliger, Gennaro Giustino, Basia Pajerski, Sebastiano Imme, Eberhard Grube, Jonathon Leipsic, Alec Vahanian, Iassen Michev, Vladimir Jelnin, Azeem Latib, Wen Cheng, Raj Makkar

Research output: Contribution to journalArticle


Objectives: This study sought to evaluate transcatheter aortic valve replacement (TAVR) in bicuspid aortic valve (BAV) aortic stenosis (AS), with a particular emphasis on TAVR-directed bicuspid aortic valve imaging (BAVi) of morphological classification. Background: TAVR has been used to treat BAV-AS but with heterogeneous outcomes and uncertainty regarding the relevance of morphology. Methods: In 14 centers in the United States, Canada, Europe, and Asia, 130 BAV-AS patients underwent TAVR. Baseline cardiac computed tomography (CT) was analyzed by a dedicated Corelab. Outcomes were assessed in line with Valve Academic Research Consortium criteria. Results: Bicommissural BAV (vs. tricommissural) accounted for 68.9% of those treated in North America, 88.9% in Europe, and 95.5% in Asia (p = 0.003). For bicommissural bicuspids, non-raphe type (vs. raphe type) BAV accounted for 11.9% of those treated in North America, 9.4% in Europe, and 61.9% in Asia (p < 0.001). Overall rates of 30-day mortality (3.8%) and cerebrovascular events (3.2%) were favorable and similar among anatomical subsets. The rate of new permanent pacemaker insertion was high (26.2%) and similar between balloon-expandable (BE) and self-expanding (SE) designs (BE: 25.5% vs. SE: 26.9%; p = 0.83); there was a trend to greater permanent pacemaker insertion in BE TAVR in the presence of coronary cusp fusion BAV morphology. Paravalvular aortic regurgitation (PAR) ≥ moderate was 18.1% overall but lower at 11.5% in those with pre-procedural CT. In the absence of pre-procedural CT, there was an excess of PAR in BE TAVR that was not the case in those with a pre-procedural CT; SE TAVR required more post-dilation. Predictors of PAR included intercommissural distance for bicommissural bicuspids (odd ratio [OR]: 1.37; 95% confidence interval [CI]: 1.02 to 1.84; p = 0.036) and lack of a baseline CT for annular measurement (OR: 3.03; 95% CI: 1.20 to 7.69; p = 0.018). Conclusions: In this multicenter study, TAVR achieved favorable outcomes in patients with pre-procedural CT, with the exception of high permanent pacemaker rates for all devices and shapes.

Original languageEnglish
JournalJACC: Cardiovascular Imaging
Publication statusAccepted/In press - Sep 14 2015



  • Aortic stenosis
  • Aortic valve replacement
  • Bicuspid aortic valve
  • TAVI
  • TAVR
  • Transcatheter aortic valve implantation
  • Transcatheter aortic valve replacement

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Radiology Nuclear Medicine and imaging

Cite this

Jilaihawi, H., Chen, M., Webb, J., Himbert, D., Ruiz, C. E., Rodés-Cabau, J., Pache, G., Colombo, A., Nickenig, G., Lee, M., Tamburino, C., Sievert, H., Abramowitz, Y., Tarantini, G., Alqoofi, F., Chakravarty, T., Kashif, M., Takahashi, N., Kazuno, Y., ... Makkar, R. (Accepted/In press). A Bicuspid Aortic Valve Imaging Classification for the TAVR Era. JACC: Cardiovascular Imaging. https://doi.org/10.1016/j.jcmg.2015.12.022