Transcatheter aortic valve replacement (TAVR) has become an increasingly important therapy option for patients with severe aortic stenosis who are not suitable for traditional aortic valve surgery. Transfemoral access remains the most utilized and preferred route for TAVR. Several alternative routes exist, including transapical, direct aortic, axillary-subclavian, transcarotid, and transcaval accesses. Many factors will be taken into account when operators determine the best vascular access, such as diameters of the access and sheater, valve size, calcification, and tortuosity. Vascular complications are the most common complications of TAVR, which are closely related to the adverse outcome and prognosis, and their occurrences are related to many factors, including the surgeon’s experience, the patient-associated factors, and the device-associated factors. The risk of vascular complications can be reduced through the choice of valve type and vascular approach, detailed preoperative imaging evaluation, and improvement of the patient’s baseline disease. It is suitable to determine whether conservative treatment or reintervention will be chosen according to the severity of the complications.
Patients with bicuspid aortic valve (BAV) are characterized by asymmetric anatomy, severe calcification and combined aortic dilatation. Compared with tricuspid aortic valve stenosis patients, patients with BAV stenosis confront with greater surgical risks in transcatheter aortic valve replacement (TAVR), including paravalvular leak, aortic valve rupture, coronary artery obstruction, atrioventricular block and so on. However, with the advent of new generation of prosthetic valves and optimization of surgical strategies, several studies have shown that TAVR is safe and effective in the treatment of BAV stenosis. Therefore, we aim to provide an overview of the use of TAVR in patients with BAV stenosis.