Key result
BAV morphology fails to accelerate post-TAVR ascending aortic expansion compared to TAV morphology.
Why the study?
Whether bicuspid aortic valve morphology inherently accelerates post-TAVR ascending aortic expansion compared with tricuspid aortic valves was uncertain.
Does bicuspid aortic valve morphology inherently accelerate post-TAVR aortic expansion compared with tricuspid aortic valves in older adults with severe aortic stenosis and concomitant ascending aortic dilatation?
Cohort (n=189)
No
Does bicuspid aortic valve morphology inherently accelerate post-TAVR aortic expansion compared with tricuspid aortic valves in older adults with severe aortic stenosis and concomitant ascending aortic dilatation?
Mean Difference: 0.04 (95% CI -0.05–0.13)
Absolute Event Rate: 0.43% vs 0.39%
p-value: p=0.364
In older adults with severe aortic stenosis and dilated ascending aortas undergoing TAVR, intermediate-term aortic expansion remains clinically slow and is not significantly accelerated by the presence of a bicuspid aortic valve.
Background Transcatheter aortic valve replacement (TAVR) addresses valvular obstruction but leaves concomitant ascending aortic dilatation untreated. Whether bicuspid aortic valve (BAV) morphology inherently accelerates post-TAVR aortic expansion compared with tricuspid aortic valves (TAV) remains uncertain. Methods This retrospective cohort study included 189 older adults (BAV, n = 87; TAV, n = 102) with severe aortic stenosis and ascending aortic dilatation (≥4.5 cm) undergoing TAVR. Annualized aortic expansion rates were evaluated utilizing linear mixed-effects models derived from serial computed tomography angiography over a median 27.0-month follow-up. Results No ascending aortic dissection, rupture, or elective aortic interventions occurred during follow-up. The adjusted annualized expansion rate at the mid-ascending aorta was low and comparable between the BAV and TAV cohorts (0.43 vs. 0.39 mm/year; interaction P = 0.364). Progression rates at the distal ascending aorta and sinuses of Valsalva similarly demonstrated no significant morphological differences. No patient exhibited rapid progression (>5 mm/year). Although moderate or greater paravalvular leakage occurred exclusively in BAV patients (4.8% vs. 0.0%; P = 0.043), its overall incidence was low (2.2%); however, the extremely small number of cases precluded a definitive statistical assessment of its impact on longitudinal aortic expansion. Conclusions In this selected cohort, dilated ascending aortas exhibited slow intermediate-term expansion following transfemoral TAVR utilizing self-expanding valves, with comparable rates between BAV and TAV morphologies. These findings suggest that conservative management of concomitant ascending aortic dilatation may be a reasonable strategy in older TAVR candidates during intermediate-term follow-up, provided that strict blood pressure control and rigorous imaging surveillance are maintained.
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Xu et al. (2026) conducted a cohort in Severe aortic stenosis with concomitant ascending aortic dilatation (n=189). Bicuspid aortic valve (BAV) morphology vs. Tricuspid aortic valve (TAV) morphology was evaluated on Adjusted annualized expansion rate at the mid-ascending aorta (mm/year) (MD 0.04, 95% CI -0.05 to 0.13, p=0.364). Bicuspid aortic valve morphology did not accelerate post-TAVR mid-ascending aortic expansion compared to tricuspid aortic valve morphology (0.43 vs. 0.39 mm/year, p=0.364) during intermediate-term follow-up.
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