Fate of dilated ascending aorta after transcatheter aortic valve replacement

<h2>Abstract</h2><h3>Objective</h3> Poststenotic ascending aortic dilation has been extensively studied, with most studies focusing on surgical aortic valve replacement outcomes. Very few studies have evaluated outcomes after transcatheter aortic valve replacement (TAVR). This study evaluated changes of poststenotic ascending aortic dilation after TAVR, as well as the incidence of aortic intervention. <h3>Methods</h3> Patients with aortic stenosis who underwent TAVR over a 5-year study period were evaluated at a single institution. All patients with ascending aortas ≥4.0 cm were included. Continuous variables were analyzed using parametric or nonparametric tests, as appropriate, and a linear regression model was used to evaluate an estimate of the progression of aortic size over time. <h3>Results</h3> In all, 115 of 1184 (9.7%) patients undergoing TAVR had a dilated ascending aorta, including 6.1% who had a bicuspid aortic valve, with 25.2% female. The average Society of Thoracic Surgeons risk score was 8.1 ± 4.2%. Median follow-up was 2.49 years (interquartile range, 0.4-6.1 years). The average aortic size preoperatively was 4.3 ± 0.3 cm. Patients with bicuspid valves had a larger mean aortic size compared with those with a tricuspid valve (4.5 ± 0.5 cm vs 4.2 ± 0.3 cm, <i>P</i> = .05). The average postoperative size was 4.01 ± 0.5 cm, which was smaller compared with the preoperative size (<i>P</i> < .001). However, a linear regression model showed no evidence that aortic size becomes smaller over continued follow-up. Importantly, only 2 patients had to undergo an aortic intervention after TAVR. <h3>Conclusions</h3> For patients with aortic stenosis and a moderate dilated ascending aorta, TAVR appears to be safe in those with a dilated ascending aorta at intermediate follow-up.