Defining Aortic Root Anatomy for Transcatheter Aortic Valve Replacement (TAVR) in the Pakistani Population: Insights From Multicenter Computed Tomography (CT) Evaluation Aortic Root Assessment and Oriented Reference for TAVR in Pakistan (AORTA-PK Reg

Background Transcatheter aortic valve replacement (TAVR) has revolutionized the treatment of aortic stenosis, yet the majority of TAVR devices are optimized for Caucasian and Latin American aortic root anatomies. Unfortunately, data specific to the South Asian (SA) population is limited. Objectives This study sought to evaluate and compare aortic root dimensions in Pakistani patients undergoing TAVR with those of other racial groups. Methods This study included consecutive patients undergoing TAVR workup at 2 tertiary care centers in Karachi, Pakistan. A comprehensive assessment of aortic root anatomy and dimensions was performed via cardiac computed tomography angiography. Data for 90 patients from a Japanese cohort and 181 patients from a European cohort were obtained from the published literature. Results In a sample of 494 patients, 58.1% (287) were male, and the mean age was 71.2 ± 9.7 years. The mean annular area was 427.33 ± 122.49 mm 2 , and the mean perimeter was 73.96 ± 10.17 mm. In comparison, the sinus of Valsalva (SOV) was <28 mm in 22.8% (113) versus 66.7% (60) versus 14% (17); left main height was <10.7 mm in 18.7% (90) versus 13.3% (12) versus 3.9% (7); and right coronary artery height was <12.7 mm in 14% (69) versus 7.8% (7) versus 2.2% (4) among the Pakistani, Japanese, and European cohorts, respectively. Conclusions The Pakistani population exhibited a higher incidence of smaller SOV dimensions compared to the European cohort and a higher incidence of shorter coronary artery heights. These findings highlight the need for tailored TAVR device designs and procedural strategies to accommodate the unique anatomical characteristics of the SA population, ensuring optimal outcomes in this demographic.