Work

Intravascular Lithotripsy-Enabled Transcatheter Aortic Valve Replacement in Heavily Calcified Bicuspid Aortic Valve

Year: 2025

Type: article

Abstract: BACKGROUND: Transcatheter aortic valve replacement (TAVR) in bicuspid aortic valves (BAVs), especially with severe calcification, presents challenges including prosthesis underexpansion and paravalvular leak. CASE SUMMARY: We present a critically unwell 70-year-old man with severe aortic stenosis in a heavily calcified Sievers-0 BAV, complicated by heart failure and chronic kidney disease. Intravascular lithotripsy (IVL) was used for calcium modification, followed by balloon valvuloplasty and deployment of a 26-mm Evolut PRO+ valve. The patient had excellent clinical recovery, with no paravalvular leak and improved ventricular function. DISCUSSION: This case highlights the novel use of IVL to facilitate TAVR in a complex calcified BAV anatomy. IVL enables controlled calcium fracture and improves compliance, optimizing prosthesis expansion and reducing complications. However, the lack of dedicated valvular IVL platforms remains a current limitation. TAKE-HOME MESSAGES: IVL may enhance lesion preparation in heavily calcified BAVs undergoing TAVR. Dedicated IVL devices for structural interventions are an emerging need.

Source: JACC Case Reports

DOI: 10.1016/j.jaccas.2025.105754

Authors: Rajan Rehan, Alexandra Moss, James Cotton, Benjamin Wrigley, Shazad Munir, Saib Khogali

Institutions: Royal Brompton & Harefield NHS Foundation Trust, Harefield Hospital, Royal Brompton Hospital, New Cross Hospital

Language: English

Topic: Cardiac Valve Diseases and Treatments

Subfield: Cardiology and Cardiovascular Medicine

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $850