{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T06:46:42Z","timestamp":1787813202644,"version":"build-2784847793"},"reference-count":43,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2022,1,27]],"date-time":"2022-01-27T00:00:00Z","timestamp":1643241600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Cardiovasc. Med."],"abstract":"<jats:p>Transcatheter aortic valve implantation (TAVI) is a well-recognized and established therapy for severe aortic stenosis, with expanding indications toward younger patients with low surgical risk profile. As bicuspid aortic valve (BAV) affects ~1\u20132% of the population, it may be speculated that an increasing number of patients with degenerated BAV may eventually need TAVI during the course of the disease. On the other hand, BAV represents a challenge due to its peculiar anatomical features and the lack of consensus on the optimal sizing strategy. The aim of this paper is to review the peculiar aspects of BAV and to discuss and compare the currently available sizing methods. Special attention is given to the role of pre-procedural imaging, mostly with multislice computed tomography, and to the aspects that operators should evaluate in order to ensure an optimal procedural planning and avoid procedural-related complications.<\/jats:p>","DOI":"10.3389\/fcvm.2021.770924","type":"journal-article","created":{"date-parts":[[2022,1,27]],"date-time":"2022-01-27T11:13:53Z","timestamp":1643282033000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":17,"title":["Bicuspid Valve Sizing for Transcatheter Aortic Valve Implantation: The Missing Link"],"prefix":"10.3389","volume":"8","author":[{"given":"Giulia","family":"Costa","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marco","family":"Angelillis","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna Sonia","family":"Petronio","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2022,1,27]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"2187","DOI":"10.1056\/NEJMoa1103510","article-title":"Transcatheter versus surgical aortic valve replacement in high-risk patients","volume":"364","author":"Smith","year":"2011","journal-title":"N Engl J Med."},{"key":"B2","doi-asserted-by":"publisher","first-page":"1790","DOI":"10.1056\/NEJMoa1400590","article-title":"Transcatheter aortic-valve replacement with a self-expanding prosthesis","volume":"370","author":"Adams","year":"2014","journal-title":"N Engl J Med."},{"key":"B3","doi-asserted-by":"publisher","first-page":"1609","DOI":"10.1056\/NEJMoa1514616","article-title":"Transcatheter or surgical aortic-valve replacement in intermediate-risk patients","volume":"374","author":"Leon","year":"2016","journal-title":"N Engl J Med."},{"key":"B4","doi-asserted-by":"publisher","first-page":"1321","DOI":"10.1056\/NEJMoa1700456","article-title":"Surgical or transcatheter aortic-valve replacement in intermediate-risk patients","volume":"376","author":"Reardon","year":"2017","journal-title":"N Engl J Med."},{"key":"B5","doi-asserted-by":"publisher","first-page":"1706","DOI":"10.1056\/NEJMoa1816885","article-title":"Transcatheter aortic-valve replacement with a self-expanding valve in low-risk patients","volume":"380","author":"Popma","year":"2019","journal-title":"N Engl J Med."},{"key":"B6","doi-asserted-by":"publisher","first-page":"1695","DOI":"10.1056\/NEJMoa1814052","article-title":"Transcatheter aortic-valve replacement with a balloon-expandable valve in low-risk patients","volume":"380","author":"Mack","year":"2019","journal-title":"N Engl J Med."},{"key":"B7","doi-asserted-by":"publisher","first-page":"2184","DOI":"10.1016\/j.jacc.2015.03.014","article-title":"Transcatheter versus surgical aortic valve replacement in patients with severe aortic valve stenosis: 1-year results from the all-comers NOTION randomized clinical trial","volume":"65","author":"Thyregod","year":"2015","journal-title":"J Am Coll Cardiol."},{"key":"B8","doi-asserted-by":"publisher","first-page":"50","DOI":"10.1001\/jamacardio.2020.4738","article-title":"Transcatheter aortic valve replacement in low-risk patients with bicuspid aortic valve stenosis","volume":"6","author":"Forrest","year":"2021","journal-title":"JAMA Cardiol."},{"key":"B9","doi-asserted-by":"publisher","first-page":"400","DOI":"10.1016\/j.ijcard.2015.08.106","article-title":"Bicuspid aortic valve aortopathy in adults: incidence, etiology, and clinical significance","volume":"201","author":"Michelena","year":"2015","journal-title":"Int J Cardiol."},{"key":"B10","doi-asserted-by":"publisher","first-page":"920","DOI":"10.1161\/01.CIR.0000155623.48408.C5","article-title":"Frequency by decades of unicuspid, bicuspid, and tricuspid aortic valves in adults having isolated aortic valve replacement for aortic stenosis, with or without associated aortic regurgitation","volume":"111","author":"Roberts","year":"2005","journal-title":"Circulation"},{"key":"B11","doi-asserted-by":"publisher","first-page":"1632","DOI":"10.1016\/j.amjcard.2012.01.390","article-title":"Frequency of congenitally bicuspid aortic valves in patients \u226580 years of age undergoing aortic valve replacement for aortic stenosis (with or without aortic regurgitation) and implications for transcatheter aortic valve implantation","volume":"109","author":"Roberts","year":"2012","journal-title":"Am J Cardiol."},{"key":"B12","doi-asserted-by":"publisher","first-page":"1390","DOI":"10.1016\/j.amjcard.2014.01.412","article-title":"Comparison of results of transcatheter aortic valve implantation in patients with severely stenotic bicuspid versus tricuspid or nonbicuspid valves","volume":"113","author":"Costopoulos","year":"2014","journal-title":"Am J Cardiol"},{"key":"B13","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1016\/j.jcin.2014.07.020","article-title":"Annular rupture during transcatheter aortic valve replacement: classification, pathophysiology, diagnostics, treatment approaches, and prevention","volume":"8","author":"Pasic","year":"2015","journal-title":"J Am Coll Cardiol Intv."},{"key":"B14","doi-asserted-by":"publisher","first-page":"2579","DOI":"10.1016\/j.jacc.2017.03.017","article-title":"Outcomes in transcatheter aortic valve replacement for bicuspid versus tricuspid aortic valve stenosis","volume":"69","author":"Yoon","year":"2017","journal-title":"J Am Coll Cardiol."},{"key":"B15","doi-asserted-by":"publisher","first-page":"2579","DOI":"10.1016\/j.jacc.2020.09.605","article-title":"Brain injury after trans catheter replacement of bicuspid versus tricuspid aortic valves","volume":"76","author":"Fan","year":"2020","journal-title":"J Am Coll Cardiol."},{"key":"B16","doi-asserted-by":"publisher","first-page":"1195","DOI":"10.1016\/j.jacc.2016.06.041","article-title":"Transcatheter aortic valve replacement with early- and new-generation devices in bicuspid aortic valve stenosis","volume":"68","author":"Yoon","year":"2016","journal-title":"J Am Coll Cardiol."},{"key":"B17","doi-asserted-by":"publisher","first-page":"1749","DOI":"10.1016\/j.jcin.2020.03.022","article-title":"Transcatheter aortic valve replacement in bicuspid versus tricuspid aortic valves from the STS\/ACC TVT registry","volume":"13","author":"Forrest","year":"2020","journal-title":"J Am Coll Cardiol Intv."},{"key":"B18","doi-asserted-by":"publisher","first-page":"1226","DOI":"10.1016\/j.jtcvs.2007.01.039","article-title":"A classification system for the bicuspid aortic valve from 304 surgical specimens","volume":"133","author":"Sievers","year":"2007","journal-title":"J Thorac Cardiovasc Surg"},{"key":"B19","doi-asserted-by":"publisher","first-page":"2691","DOI":"10.1161\/CIRCULATIONAHA.113.007851","article-title":"Bicuspid aortic valve: identifying knowledge gaps and rising to the challenge from the International Bicuspid Aortic Valve Consortium (BAVCon)","volume":"129","author":"Michelena","year":"2014","journal-title":"Circulation."},{"key":"B20","doi-asserted-by":"publisher","first-page":"1145","DOI":"10.1016\/j.jcmg.2015.12.022","article-title":"A Bicuspid Aortic Valve Imaging Classification for the TAVR Era","volume":"9","author":"Jilaihawi","year":"2016","journal-title":"J Am Coll Cardiol Img."},{"key":"B21","doi-asserted-by":"publisher","first-page":"1018","DOI":"10.1016\/j.jacc.2020.07.005","article-title":"Bicuspid aortic valve morphology and outcomes after transcatheter aortic valve replacement","volume":"76","author":"Yoon","year":"2020","journal-title":"J Am Coll Cardiol."},{"key":"B22","doi-asserted-by":"publisher","first-page":"1920","DOI":"10.1056\/NEJMra1207059","article-title":"Aortic dilatation in patients with bicuspid aortic valve","volume":"370","author":"Verma","year":"2014","journal-title":"N Engl J Med."},{"key":"B23","first-page":"901","article-title":"The aortopathy of bicuspid aortic valve disease has distinctive patterns and usually involves the transverse aortic arch","volume-title":"J Thorac Cardiovasc Surg","author":"Fazel","year":"2008"},{"key":"B24","doi-asserted-by":"publisher","first-page":"397","DOI":"10.1016\/j.ejcts.2006.12.006","article-title":"Predictors of ascending aortic dilatation with bicuspid aortic valve: a wide spectrum of disease expression","volume":"31","author":"Della Corte","year":"2007","journal-title":"Eur J Cardiothorac Surg"},{"key":"B25","doi-asserted-by":"publisher","first-page":"439","DOI":"10.1093\/ejcts\/ezv087","article-title":"New insights in the association between bicuspid aortic valve phenotype, aortic configuration and valve haemodynamics","volume":"49","author":"Sievers","year":"2016","journal-title":"Eur J Cardiothorac Surg."},{"key":"B26","doi-asserted-by":"publisher","first-page":"1707","DOI":"10.1016\/j.athoracsur.2015.10.047","article-title":"Impact of aortic insufficiency on ascending aortic dilatation and adverse aortic events after isolated aortic valve replacement in patients with a bicuspid aortic valve","volume":"101","author":"Wang","year":"2016","journal-title":"Ann Thorac Surg."},{"key":"B27","doi-asserted-by":"publisher","first-page":"1365","DOI":"10.2119\/molmed.2011.00286","article-title":"Unraveling divergent gene expression profiles in bicuspid and tricuspid aortic valve patients with thoracic aortic dilatation: the ASAP study","volume":"17","author":"Folkersen","year":"2011","journal-title":"Mol Med."},{"key":"B28","doi-asserted-by":"publisher","first-page":"1822","DOI":"10.1136\/heartjnl-2012-302828","article-title":"Aortopathy and bicuspid aortic valve: haemodynamic burden is main contributor to aortic dilatation","volume":"98","author":"Kim","year":"2012","journal-title":"Heart."},{"key":"B29","doi-asserted-by":"publisher","first-page":"43","DOI":"10.1093\/ejcts\/ezs155","article-title":"Computed tomography-based evaluation of aortic annulus, prosthesis size and impact on early residual aortic regurgitation after transcatheter aortic valve implantation","volume":"43","author":"Buzzatti","year":"2013","journal-title":"Eur J Cardiothorac Surg"},{"key":"B30","doi-asserted-by":"publisher","first-page":"366","DOI":"10.1016\/j.jcct.2012.11.002","article-title":"expert consensus document on computed tomography imaging before transcatheter aortic valve implantation (TAVI)\/transcatheter aortic valve replacement (TAVR)","volume":"6","author":"Achenbach","year":"2012","journal-title":"J Cardiovasc Comput Tomogr."},{"key":"B31","doi-asserted-by":"publisher","first-page":"67","DOI":"10.1016\/j.jcct.2013.12.020","article-title":"Oversizing in transcatheter aortic valve replacement, a commonly used term but a poorly understood one: dependency on definition and geometrical measurements","volume":"8","author":"Blanke","year":"2014","journal-title":"J Cardiovasc Comput Tomogr."},{"key":"B32","doi-asserted-by":"publisher","first-page":"463","DOI":"10.21037\/acs.2017.09.03","article-title":"Clinical outcomes and prognostic factors of transcatheter aortic valve implantation in bicuspid aortic valve patients","volume":"6","author":"Yoon","year":"2017","journal-title":"Ann Cardiothorac Surg."},{"key":"B33","doi-asserted-by":"publisher","first-page":"2330","DOI":"10.1016\/j.jacc.2014.09.039","article-title":"Transcatheter aortic valve replacement in bicuspid aortic valve disease","volume":"64","author":"Mylotte","year":"2014","journal-title":"J Am Coll Cardiol."},{"key":"B34","doi-asserted-by":"publisher","first-page":"e007107","DOI":"10.1161\/CIRCINTERVENTIONS.118.007107","article-title":"Bicuspid aortic valve anatomy and relationship with devices: the BAVARD multicenter registry","volume":"12","author":"Tchetche","year":"2019","journal-title":"Circ Cardiovasc Interv."},{"key":"B35","doi-asserted-by":"publisher","first-page":"e231","DOI":"10.4244\/EIJ-D-19-00236","article-title":"Annular versus supra-annular sizing for TAVI in bicuspid aortic valve stenosis","volume":"15","author":"Kim","year":"2019","journal-title":"EuroIntervention."},{"key":"B36","doi-asserted-by":"publisher","first-page":"407","DOI":"10.1016\/j.jcct.2020.01.008","article-title":"Annular versus supra-annular sizing for transcatheter aortic valve replacement in bicuspid aortic valve disease","volume":"14","author":"Weir-McCall","year":"2020","journal-title":"J Cardiovasc Comput Tomogr."},{"key":"B37","doi-asserted-by":"publisher","first-page":"274","DOI":"10.1016\/j.jcmg.2012.06.014","article-title":"Fluoroscopy-guided aortic root imaging for TAVR: \u201cfollow the right cusp\u201d rule","volume":"6","author":"Kasel","year":"2013","journal-title":"J Am Coll Cardiol Img."},{"key":"B38","doi-asserted-by":"publisher","first-page":"986","DOI":"10.1002\/ccd.27467","article-title":"Supra-annular structure assessment for self-expanding transcatheter heart valve size selection in patients with bicuspid aortic valve","volume":"91","author":"Liu","year":"2018","journal-title":"Catheter Cardiovasc Interv."},{"key":"B39","doi-asserted-by":"publisher","first-page":"452","DOI":"10.1016\/j.jcct.2020.01.007","article-title":"Bicuspid aortic valve sizing for transcatheter aortic valve implantation: development and validation of an algorithm based on multi-slice computed tomography","volume":"14","author":"Petronio","year":"2020","journal-title":"J Cardiovasc Comput Tomogr."},{"key":"B40","doi-asserted-by":"publisher","first-page":"144","DOI":"10.1016\/j.ijcard.2020.05.076","article-title":"Supra-annular sizing of transcatheter aortic valve prostheses in raphe-type bicuspid aortic valve disease: the LIRA method","volume":"317","author":"Iannopollo","year":"2020","journal-title":"Int J Cardiol."},{"key":"B41","doi-asserted-by":"publisher","first-page":"147","DOI":"10.1016\/j.jacasi.2021.07.012","article-title":"Application of balloon-expandable transcatheter heart valve in bicuspid aortic valve","volume":"1","author":"Mi","year":"2021","journal-title":"JACC Asia."},{"key":"B42","doi-asserted-by":"publisher","first-page":"332","DOI":"10.3904\/kjim.2019.089","article-title":"Progression of ascending aortopathy may not occur after transcatheter aortic valve replacement in severe bicuspid aortic stenosis","volume":"36","author":"Jung","year":"2021","journal-title":"Korean J Intern Med."},{"key":"B43","doi-asserted-by":"publisher","first-page":"53","DOI":"10.2217\/ica.12.73","article-title":"Engineering perspective on transcatheter aortic valve implantation","volume":"5","author":"Tseng","year":"2013","journal-title":"Interv Cardiol."}],"container-title":["Frontiers in Cardiovascular Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fcvm.2021.770924\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,1,27]],"date-time":"2022-01-27T11:13:59Z","timestamp":1643282039000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fcvm.2021.770924\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,1,27]]},"references-count":43,"alternative-id":["10.3389\/fcvm.2021.770924"],"URL":"https:\/\/doi.org\/10.3389\/fcvm.2021.770924","relation":{},"ISSN":["2297-055X"],"issn-type":[{"value":"2297-055X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,1,27]]},"article-number":"770924"}}