Impact of transcatheter aortic valve replacement on aortic root remodeling: a pre- and post-procedure CTA comparative analysis

Transcatheter aortic valve replacement (TAVR) induces anatomical changes in the aortic root; however, the hemodynamic relevance of post-procedural geometric remodeling remains incompletely understood. We retrospectively analyzed 117 patients with severe aortic stenosis who underwent transapical TAVR using the self-expanding Xcor system (Saint Medical Technology, Nanjing, China) and had paired pre-procedural and 1-year post-procedural computed tomography angiography (CTA). Changes in aortic root dimensions and annulus angle were quantified. Hemodynamic outcomes were assessed by 1-year echocardiography. A composite adverse hemodynamic outcome was defined as mean pressure gradient ≥ 20 mmHg or Doppler velocity index < 0.35. At 1 year, TAVR resulted in statistically significant but modest expansion of the sinus of Valsalva (+ 2.6 mm, + 6.8%) and sinotubular junction (+ 1.6 mm, + 5.0%), with only 10.3% of patients exceeding predefined dimensional thresholds. Root dimensional expansion was not associated with adverse hemodynamic outcomes. In contrast, greater annulus angle change and higher baseline annular calcium volume were independently associated with increased transvalvular gradients. Patients with both risk factors had significantly higher rates of adverse hemodynamic outcomes (26.3% vs. 4.3%, p = 0.008). Transapical TAVR using the self-expanding Xcor system induces predominantly hemodynamically modest aortic root remodeling at 1 year. Root expansion appears to represent adaptive remodeling without adverse hemodynamic consequences, whereas an exploratory analysis suggests that excessive annulus angle change combined with severe calcification may be associated with suboptimal hemodynamic performance, though these findings require validation.