The adult congenital heart disease (ACHD) population is steadily growing and aging, exposing patients to age-related cardiovascular conditions, particularly degenerative aortic valve disease. While transcatheter aortic valve implantation (TAVI) is a standard treatment in the general population, experience in ACHD remains very limited.

Retrospective single-center study including all ACHD patients who underwent TAVI between January 2024 and January 2026. Procedural characteristics, periprocedural outcomes, complications, and events during follow-up were analyzed. The primary endpoint was periprocedural mortality; secondary endpoints included complications, NT-proBNP changes, and aortic bioprosthesis function.

A total of 8 patients (median age 67.5 years, 56.8–76.3) with moderate or complex CHD were included. Two had genetic syndromes (Williams–Beuren, trisomy 21), and seven (87.5%) had prior heart failure hospitalization. Median NT-proBNP was 2387 pg/mL, and median systolic pulmonary artery pressure 56 mmHg. Seven patients underwent transfemoral TAVI; one required a carotid approach due to severe diffuse arterial hypoplasia. One patient experienced ventricular fibrillation, which was successfully cardioverted during valve implantation, and another patient developed paroxysmal complete atrioventricular block requiring leadless pacemaker implantation. No periprocedural deaths occurred. At 3-month follow-up, all valves showed excellent hemodynamic performance, with no significant regurgitation or heart failure rehospitalization, and NT-proBNP decreased significantly ( P = 0.034).

This series represents, to our knowledge, the largest published experience of TAVI in adult patients with moderate to complex congenital heart disease. TAVI is feasible and safe in carefully selected ACHD patients when performed in a specialized, multidisciplinary setting, and is expected to become an increasingly important therapeutic option as this population continues to age.