Background: Prior data suggest a correlation of the THV position and the occurrence of complications after TAVI in patients with tricuspid aortic valves (TAV). The purpose of this study was to investigate transcatheter heart valve (THV) position after transcatheter aortic valve implantation (TAVI) in bicuspid aortic valves (BAV), since data for these valves are scarce.

Methods: We evaluated the THV position in 50 BAV and 50 TAV patients (all received the balloon-expandable Sapien 3 prosthesis) using fusion imaging of pre- and post-procedural computed tomography angiography. According to the manufacturers recommendations a low implantation position was defined as >30% of the prosthesis below the annulus. The deployed THV area was quantified to determine the average expansion of the prosthesis as percent of the nominal area. The area measurements of the stent center compared to the average of the stent entry and exit were used to assess the extent of prosthesis waist in percent.

Results: In BAV we identified a higher amount of calcification of the device landing zone (P=0.019). The THV position was appropriate in the majority of the patients within both groups (90.0% for BAV vs. 96.0% for TAV, P=0.240). In BAV we observed a more pronounced THV waist (7.4±4.5% vs. 5.8±3.0%, P=0.043) and a lower average THV expansion (91.9±12.2% vs. 95.5±2.7% of nominal expansion, P=0.044).

Conclusions: Positioning of the Sapien 3 for TAVI in BAV is feasible and safe. Thus, there is a more pronounced prosthesis waist and a lower average THV expansion in BAV compared with TAV.