AUTHOR=Elkoumy Ahmed , Terkelsen Christian J. , Abdelshafy Mahmoud , Ellert-Gregersen Julia , Elzomor Hesham , Thim Troels , Serruys Patrick W. , Soliman Osama , Nissen Henrik 

TITLE=Case report: Transcatheter aortic valve replacement in a large bicuspid anatomy using the XL-Myval 32 mm

JOURNAL=Frontiers in Cardiovascular Medicine

VOLUME=Volume 9 - 2022

YEAR=2022

URL=https://www.frontiersin.org/journals/cardiovascular-medicine/articles/10.3389/fcvm.2022.1045280

DOI=10.3389/fcvm.2022.1045280

ISSN=2297-055X

ABSTRACT=Transcatheter aortic valve replacement (TAVR) is a recommended intervention in a selected population with severe aortic stenosis (AS). Bicuspid aortic valve (BAV) anatomy has been categorized as unfavorable anatomy for TAVR, due to multiple considerations, like the exclusion from randomized trials in addition, to the challenging and unpredictable anatomy. The anatomical constraints of BAV include the large anatomy of the annulus, sinuses of Valsalva and aorta (aortopathy), in addition to the significant calcifications of the device landing zone. Most of commercial transcatheter heart valves (THV) have an upper limit of the annulus dimensions and area in which the device can be implanted safely without significant oversizing. Myval-XL THVs (Meril Life Sciences Pvt. Ltd, India) are balloon-expandable valves (BEV) which developed with two new sizes of 30.5, and 32mm, aiming to treat patients with large annulus dimensions and exceeding the upper limit of the ordinary device sizing matrix. This case series report is describing TAVR using the XL-Myval 32mm THV in three European patients with symptomatic severe bicuspid aortic stenosis with significant calcifications and large annular dimensions exceeding the limits of the other THVs.