Patient selection
This study was a retrospective registry from 3 centers (Helsinki University Hospital, Finland; Oulu University Hospital, Finland and Shonan Kamakura General Hospital, Japan). Patients with BAV stenosis who underwent TAVR were eligible for the study. Out of 195 eligible patients from 3 centers, 26 patients (intraprocedural death: 0, implantation failure: 2, poor CT image quality: 1, poor angiogram quality: 5, prior PPI: 17) were excluded from the analysis (Figure 1 ). After exclusion, 169 patients remained for further analysis. BAV morphology was confirmed by pre-procedural MDCT and determined using the Sievers classification (20 ). TAV cohort was established to compare with BAV cohort by using propensity score (PS) matching. The inclusion criteria of TAV cohort were patients with TAV stenosis who underwent TAVR at Helsinki university hospital. Exclusion criteria were the same as the BAV cohort. THV size was selected based on the integration of preprocedural MDCT assessment including annulus area size and inter-commissural distance (ICD) at 4mm above the annulus by the multidisciplinary heart team at the individual hospital. This study was conformed to the Declaration of Helsinki and approved by the Institutional Review Board in Helsinki.