Key result
Ascending aortic dilatation before TAVR is not associated with worse long-term survival.
Why the study?
In patients with severe AS undergoing TAVR, survival data regarding aortic changes and laboratory biomarker analyses were scarce.
Does ascending aortic dilatation impair survival or correlate with specific clinical biomarkers in patients with severe aortic stenosis undergoing TAVR?
Cohort (n=179)
Yes
Does ascending aortic dilatation impair survival or correlate with specific clinical biomarkers in patients with severe aortic stenosis undergoing TAVR?
Ascending aortic dilatation in patients undergoing TAVR does not worsen mid-term mortality and is inversely associated with diabetes mellitus.
The absence of a mid-term survival penalty suggests concurrent aortic dilatation may not require altering TAVR.
Both relevant aortic valve stenosis (AS) and aortic valve insufficiency significantly contribute to structural changes in the ascending aorta (AA) and thus to its dilatation. In patients with severe AS undergoing transcatheter aortic valve replacement (TAVR), survival data regarding aortic changes and laboratory biomarker analyses are scarce. Methods: A total of 179 patients with severe AS and an available computed tomography were included in this retrospective study. AA was measured, and dilatation was defined as a diameter ≥ 40 mm. Thirty-two patients had dilatation of the AA. A further 32 patients from the present population with a normal AA were matched to the aortic dilatation group with respect to gender, age, body mass index and body surface area, and the resulting study groups were compared with each other. In addition to echocardiographic and clinical characteristics, the expression of cardiovascular biomarkers such as brain natriuretic peptide (BNP), soluble suppression of tumorigenicity-2 (sST2), growth/differentiation of factor-15 (GDF-15), heart-type fatty-acid binding protein (H-FABP), insulin-like growth factor binding protein 2 (IGF-BP2) and soluble urokinase-type plasminogen activator receptor (suPAR) was analyzed. Kaplan–Meier curves for short- and long-term survival were obtained, and Pearson’s and Spearman’s correlations were calculated to identify the predictors between the diameter of the AA and clinical parameters. Results: A total of 19% of the total cohort had dilatation of the AA. The study group with an AA diameter ≥ 40 mm showed a significantly low comorbidity with respect to diabetes mellitus in contrast to the comparison cohort with an AA diameter < 40 mm (p = 0.010). This result continued in the correlation analyses performed, as the presence of diabetes mellitus correlated negatively not only with the diameter of the AA (r = −0.404; p = 0.001) but also with the presence of aortic dilatation (r = −0.320; p = 0.010). In addition, the presence of AA dilatation after TAVR was shown to have no differences in terms of patient survival at 1, 3 and 5 years. There were no relevant differences in the cardiovascular biomarkers studied between the patients with dilated and normal AAs. Conclusion: The presence of AA dilatation before successful TAVR was not associated with a survival disadvantage at the respective follow-up intervals of 1, 3 and 5 years. Diabetes mellitus in general seemed to have a protective effect against the development of AA dilatation or aneurysm in patients with severe AS.
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Boxhammer et al. (2023) conducted a cohort in Severe aortic stenosis (n=179). Ascending aortic dilatation (≥ 40 mm) vs. Normal ascending aorta (< 40 mm) was evaluated on 1-year survival (p=0.604). Ascending aortic dilatation before TAVR was negatively correlated with the presence of diabetes mellitus and was not associated with a survival disadvantage at 1, 3, or 5 years post-procedure.
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