Background: Transcatheter aortic valve implantation (TAVI) is a safe and effective alternative to surgical replacement in patients with tricuspid aortic valve anatomy (TAV). There is still controversy on the treatment of patients with bicuspid aortic valve (BAV) anatomy with TAVI.

Objective: To analyse the immediate and early outcomes of patients with BAV anatomy type Sievers 0 and Sievers 1 treated with TAVI compared to patients with TAV at a large single centre.

Methods and Results: 2010 patients treated with transcatheter aortic valve implantation at our centre between 2016 and 2020 were screened. After exclusion of 73 patients with valve-in-valve treatments and 46 patients with non-available preprocedural CT for evaluation 1891 patients were included. Preprocedural compted tomographies were retrospectivly evaluated for the presence of bicuspid valve Sievers type 0 or 1. In 76 patients (4.02%) BAV was present before TAVI with 14 patients having Sievers type 0 morphology (0.74%) and 62 patients Sievers type 1 morphology (3.28%). The rate of type 0 BAV was 18,4% of all BAV. Patients with BAV were significantly younger compared to patients with tricuspid aortic valve TAV (75.72±7.57; p<0.001), BMI was lower (26.12±4.9 vs. 27.40±5.26; p=0.037) as well as risk scores (STS-PROM 3.36%±2.78 vs. 4.53%±3.65; p=0.009; EuroScore II 3.68±3.36 vs. 5.68±5.59; p=0.006). There was a numerically yet not statistically lower rate of history of atrial fibrillation in the group of patients with BAV (27.3% vs. 27.5%, p=0.068). All other baseline parameters showed no relevant difference between groups. Echocardiography revealed higher gradients and smaller aortic valve area in patients with BAV (P mean 45.47±16.46 vs. 40.45±15.23; p=0.006, AVA 0.7±0.18 vs. 0.78±0.21; p<0.001). Device success was high in both groups (BAV 96.88% vs. TAV 97.08%, p=0.92), there was no intraprocedural death in patients with BAV. Patients with BAV did not experience moderate or severe aortic regurgitation (AR), none or trace AR was present in 85.14% and mild AR in 14.86% compared to 85.4% none/trace AR, 14.0% mild AR and 0.46% moderate AR in TAVI patients (p=0.44). There was no statistically significant difference in stroke rate (3.95% vs. 2.46%, p=0.42), postprocedural pacemaker implantation (18.4% vs. 14.5%, p=0.35) or mortality of any cause within 30 days (2.63% vs- 1.76%, p=0.58) in patients with BAV.

Conclusion: Rate of BAV was low with 4.02% as expected in a western patient collective. Immediate and early outcome showed TAVI to be a safe and effective treatment option in these patients.