Bicuspid Aortic Valve – Therapeutic Options Today and Tomorrow

Abstract

Bicuspid Aortic Valve (BAV) is the most common congenital heart defect, characterized by the presence of two cusps of the valve instead of three. This defect leads to hemodynamic and morphological disturbances, potentially resulting in serious health complications. BAV often remains asymptomatic for a long time, with symptoms eventually arising from valve degeneration along with the remodeling of the heart and aortic root, which are consequences of the initial condition. The aim of this study is to compile information regarding the defect, current treatment options, and potential new therapeutic directions. The classical approach for treatment is surgical aortic valve replacement (SAVR), which involves replacing the abnormal valve with either a mechanical or biological prosthesis through access via sternotomy. Mechanical valves are characterized by their longer lifespan but require ongoing anticoagulant therapy, whereas biological valves do not necessitate anticoagulation, although they tend to have a shorter durability. An alternative to SAVR is minimally invasive transcatheter aortic valve replacement (TAVR), which offers a shorter recovery time but limited long-term durability data restricts its use in younger patients. Other treatment options include the Ross procedure and valvuloplasty procedures, which may serve as viable solutions for pediatric patients. Despite the availability of different treatment methods, the selection of an appropriate therapeutic strategy remains a challenge, as each option carries distinct benefits and risks. Patient education plays a crucial role in the decision-making process, helping to alleviate anxiety and improve treatment outcomes. Emerging fields such as medical bioengineering might offer promising solutions in the future for patients with BAV.