Key result
Continuous aortic dilatation affects ~15% of bicuspid TAVI patients, linked to higher raphe length ratio.
Why the study?
Patients undergoing TAVI for bicuspid AS frequently have untreated ascending aortic dilatation, but its natural progression and underlying mechanisms remain to be studied.
Cohort (n=61)
Yes
Ascending aortic dilatation remains stable in 85% of patients with bicuspid aortic stenosis undergoing TAVI at nearly 3 years follow-up, with progression associated with specific valve anatomical and procedural factors.
Answers are grounded in this paper and cite their sources.
May support targeted AAo surveillance post-TAVI in bicuspid AS; hypothesis-generating and requires prospective validation.
BACKGROUND: Patients undergoing transcatheter aortic valve implantation (TAVI) for bicuspid aortic stenosis (AS) frequently present with ascending aortic (AAo) dilatation which is left untreated. The objective of this study was to study the natural progression and underlying mechanisms of AAo dilatation after TAVI for bicuspid AS. METHODS: Patients with a native bicuspid AS and a baseline AAo maximum diameter > 40 mm treated by TAVI and in whom post-TAVI computed tomography (CT) scans beyond 1 year were available were included. AAo dilatation was deemed to be either continuous (≥ 2 mm increase) or stable (< 2 mm increase or decrease). Uni- and multivariate logistic regression analysis was utilized in order to identify factors associated with continuous AAo dilatation post-TAVI. RESULTS: A total of 61 patients with a mean AAo maximum diameter of 45.6 ± 3.9 mm at baseline were evaluated. At a median follow-up of 2.9 years, AAo dimensions remained stable in 85% of patients. Continuous AAo dilatation was observed in 15% of patients at a rate of 1.4 mm/year. Factors associated with continuous AAo dilatation were raphe length/annulus mean diameter ratio (OR 4.09, 95% CI [1.40-16.7], p = 0.022), TAV eccentricity at the leaflet outflow level (OR 2.11, 95%CI [1.12-4.53], p = 0.031) and maximum transprosthetic gradient (OR 1.30, 95%CI [0.99-1.73], p = 0.058). CONCLUSIONS: Ascending aortic dilatation in patients undergoing TAVI for bicuspid AS remains stable in the majority of patients. Factors influencing TAV stent frame geometry and function were identified to be associated with continuous AAo dilatation after TAVI; this should be confirmed in future larger cohort studies.
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Jia et al. (2024) conducted a cohort in Bicuspid aortic stenosis with baseline ascending aortic dilatation (n=61). Elevated raphe length to aortic annulus mean diameter ratio vs. Lower ratio was evaluated on Continuous ascending aortic dilatation (≥ 2 mm increase) (OR 5.67, 95% CI 1.50-35.3, p=0.026). In patients undergoing TAVI for bicuspid aortic stenosis, continuous ascending aortic dilatation occurred in 15% of patients and was independently predicted by a higher raphe length to annulus mean diameter ratio.
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