Transfemoral implantation of CoreValve Evolut R in patient with functionally bicuspid aortic valve

Catheter based aortic valve replacement became largely adopted technique to treat patients with severe aortic stenosis in the setting of prohibitive risk and in high risk operation patients. Based on the positive clinical data from the Nordic Aortic Valve Intervention (NOTION) Trial [1] and from a subset analysis from the CoreValve U.S. High Risk Pivotal Trial Medtronic plc. announced CE mark for the self-expanding CoreValve™ Evolut™ R to obtain an expanded indication to treat aortic stenosis in patients who are at intermediate risk for open-heart surgery. Bicuspid aortic valve was deemed contraindicated for CoreValve implantation and nowadays is considered to be “off label” use even if multiple publications showed successful CoreValve implantation in patients with stenotic bicuspid aortic valve [2], [3]. Current case report tackles preprocedural evaluation of stenotic aortic valve anatomy and together with the relevant pictures illustrates recapurability and repositionability of abovementioned TAVI system in patient with funcionally bicuspid severely stenotic aortic valve.