Short- to mid-term outcomes after transcatheter aortic valve replacement in patients with ascending aorta dilation: a single-centre retrospective analysis

Abstract

Objectives: Ascending aorta dilation (AAD) is frequently associated with aortic stenosis (AS). This study investigated the procedural and clinical outcomes of transcatheter aortic valve replacement (TAVR) in patients with AAD for tricuspid AS. Methods: This is a single-centre retrospective study that included patients with tricuspid AS and who underwent TAVR between January 1, 2018 and December 31, 2021. A total of 239 patients met the inclusion criteria. The ascending aortic diameter was measured on computed tomography (CT) scans before TAVR, and AAD was identified as a maximal ascending aortic diameter of ≥ 40 mm. The outcomes were in line with the Valve Academy Research Consortium (VARC)-3 criteria. Results: Self-expandable (SE) valves were used in 88.7% of the total cohort (89.0% in the AAD group and 88.6% in the non-AAD group). Seventy-three patients (30.5%) were diagnosed with concomitant AAD (mean age 73.7 ± 7.3 years, 57.5% male). The median ascending aortic diameter was 36.0 mm (interquartile range [IQR]: 34.0–37.0 mm) in the non-AAD group and 44.0 mm (IQR: 42.0–46.0 mm) in the AAD group (p < 0.001). The baseline characteristics were comparable across the groups. No significant difference was observed in cumulative all-cause mortality at 30 days (2.4% vs. 1.4%, p = 0.609), 1 year (9.2% vs. 5.0%, p = 0.191), or 3 years (13.1% vs. 9.5%, p = 0.201) between the non-AAD and AAD groups. The device success rate was not different between the non-AAD and AAD groups (74.7% vs. 82.2%, p = 0.205). The multivariable analysis identified prior percutaneous coronary intervention, prior stroke, and length of intensive care unit as independent predictors of 3-year all-cause mortality among the total cohort. Conclusion: AAD does not appear to be associated with the procedural and mid-term clinical outcomes in patients undergoing TAVR.