A newly developed five-indicator anatomic score, derived from routine preprocedural CT and echocardiography, predicts intraprocedural complications during transcatheter aortic valve implantation (TAVI) in patients with bicuspid aortic valve (BAV). Across a development cohort of 793 patients, complication rates rose steeply by risk stratum: 7.2%, 13.3%, and 30.6%. Each additional score point carried a 32% higher odds of adverse intraprocedural events (OR 1.32; 95% CI 1.18–1.47). External validation in 134 patients confirmed the gradient, with high-risk patients reaching a 50% complication rate and a C-statistic of 0.725.
Bicuspid aortic valve anatomy has long been a relative exclusion criterion in landmark TAVI trials, yet BAV disease accounts for a substantial share of severe aortic stenosis in younger patients increasingly considered for transcatheter approaches. Existing risk scores — EuroSCORE II, STS — capture general surgical risk but not the procedural intricacies unique to BAV morphology, such as elliptical annuli, asymmetric calcification, and aortopathy. This score fills a genuine gap by grounding risk prediction in anatomy rather than comorbidity burden. The external validation cohort, though modest at 134 patients, supports generalizability across centers. Importantly, higher score categories also tracked with worse 30-day and 1-year mortality, giving the tool longitudinal relevance beyond the procedure room. Limitations include retrospective design, relatively small validation sample, and predominantly Asian center representation. As a preprint not yet peer-reviewed, findings require independent replication before clinical adoption. Still, this represents a meaningfully incremental advance for procedural planning in a growing, underserved TAVI subpopulation.