Imaging, Treatment Options, Patient Selection, and Outcome Considerations for Patients With Bicuspid Aortic Valve Disease

Transcatheter aortic valve replacement has emerged as a safe and effective alternative to surgical aortic valve replacement for patients with severe symptomatic aortic stenosis across the spectrum of surgical risks based on a series of foundational randomized clinical trials. Of note, patients with bicuspid aortic valve (BAV) disease were excluded from all these pivotal randomized trials, leaving a significant knowledge gap because BAVs are commonly encountered in patients referred for aortic valve surgery or intervention. In this comprehensive review, we aim to provide heart teams with a detailed insight into how to approach patients with BAV disease, focusing on imaging and characterization of bicuspid valves, an overview of surgical approaches, and an understanding of the current data behind the role of transcatheter aortic valve replacement for patients with BAV disease. [Display omitted] •A comprehensive review of bicuspid valve disease, focusing on imaging and therapeutic options.•Detailed discussion of multimodality imaging for bicuspid aortic valve disease.•Approaches to surgery and transcatheter aortic valve replacement.•Discussion of available data and technical considerations.•Emphasis on multidisciplinary heart team evaluation at dedicated valve centers.