The impact of ascending aorta dilatation on transcatheter aortic valve implantation outcomes

The impact of ascending aorta dilatation (AAD) on transcatheter aortic valve implantation (TAVI) outcomes, compared to non-AAD, remains unclear. This meta -analysis aims to compare the outcomes of TAVI between patients with and without AAD. We systematically searched PubMed, ScienceDirect, Web of Science, Springer, Cochrane, and Clinicaltrials.gov . for articles up to 25 March 2024 (PROSPERO ID CRD42024526311). A total of 204,078 patients from ten studies were included. Paravalvular regurgitation (RR 1.56 95 %CI: 1.32–1.84, p < 0.00001, I 2 = 0 %) and aortic dissection (RR 3.55 95 %CI: 1.79–7.06, p = 0.0003, I 2 = 40 %) were more common in AAD group. However, there were no differences in peri -procedural (RR 1.09, 95 %CI: 0.83–1.42, p = 0.53, I 2 = 0 %) and 1-year (RR 0.79, 95 %CI: 0.51–1.23, p = 0.30, I 2 = 0 %) mortality. Three-years (RR 0.88, 95 %CI: 0.54–1.44, p = 0.62) and five-years (RR 0.85, 95 %CI: 0.45–1.6, p = 0.61) follow-up showed comparable mortality between both groups. The other complications and the need for second valve implantation (RR 1.24, 95 %CI: 0.70–20.20, p = 0.48, I 2 = 65 %) were similar between both groups. Despite the higher incidence of aortic dissection and paravalvular regurgitation in AAD than in non-AAD patients, these complications were not associated with worse short-term or long-term mortality. Therefore, TAVI remains a safe and effective option for AAD patients.