In China, bicuspid aortic valve (BAV) represents a significantly high proportion of the transcatheter aortic valve replacement (TAVR) population. The application of TAVR in patients with BAV is challenging due to complex anatomy. To date, no prospective study has evaluated the Sapien 3 TAVR in patients with Type-0 BAV.

Inclusion Criteria:

• Age ≥50 years, and after thorough physician-patient discussion and shared decision-making, willing to undergo or accept TAVR.

• Severe AS, defined as follows:

  a) For symptomatic patients: i) Aortic valve area ≤1.0 cm2 (or aortic valve area index of ≤0.6 cm2/m2), OR mean gradient ≥40 mm Hg, OR Maximal aortic valve velocity ≥4.0 m/sec by transthoracic echocardiography at rest b) For asymptomatic patients: i) Very severe AS with an aortic valve area of ≤1.0 cm2 (or aortic valve area index of ≤0.6 cm2/m2), AND maximal aortic velocity ≥5.0 m/sec, or mean gradient ≥60 mm Hg by transthoracic echocardiography at rest, OR ii) Aortic valve area of ≤1.0 cm2 (or aortic valve area index of ≤0.6 cm2/m2), AND a mean gradient ≥40 mm Hg or maximal aortic valve velocity ≥4.0 m/sec by transthoracic echocardiography at rest, AND an exercise tolerance test that demonstrates a limited exercise capacity, abnormal BP response, or arrhythmia OR iii) Aortic valve area of ≤1.0 cm2 (or aortic valve area index of ≤0.6 cm2/m2), AND mean gradient ≥40 mmHg, or maximal aortic valve velocity ≥4.0 m/sec by transthoracic echocardiography at rest, AND a left ventricular ejection fraction <50%.

• Type-0 bicuspid aortic valve anatomy confirmed by multi-detector computed tomography (MDCT).

• The subject and the treating physician agree that the subject will return for all required post-procedure follow-up visits.

• Adequate iliofemoral access and acceptable level of vessel calcification and tortuosity for safe device implant.

• The study patient has provided written informed consent.

Exclusion Criteria:

• Challenging calcification based on physician's experience and discretion
• Aortic valve is a congenital unicuspid valve, congenital Type-1 or Type-2 bicuspid valve, tricuspid or quadricuspid valve
• Severe femoral, iliac or aortic atherosclerosis, calcification, coarctation, aneurysm or tortuosity, which prevents transfemoral TAVR
• Need for open heart surgery (including severe aortic regurgitation, mitral regurgitation or stenosis, or tricuspid regurgitation, congenital heart disease, AF, complex coronary artery disease)
• Pre-existing mechanical or bioprosthetic valve in any position
• Hemodynamic or respiratory instability requiring inotropic support, mechanical ventilation or mechanical heart assistance within 30 days of the screening visit
• Emergency interventional/surgical procedures within 30 days of the valve implant procedure
• Hypertrophic cardiomyopathy with obstruction
• Ventricular dysfunction with LVEF < 30%
• Cardiac imaging (echo, CT, and/or MRI) evidence of ventricular mass, thrombus or vegetation
• Renal replacement therapy at the time of screening
• Estimated life expectancy < 12 months
• Currently participating in an investigational drug or another device study. Note: Trials requiring extended follow-up for products that were investigational, but have since become commercially available, are not considered investigational trials. Observational studies are not considered exclusionary.

severe symptomatic aortic valve stenosis (AS) patients with type-0 bicuspid anatomy