Temporal changes in dilated ascending aorta after transfemoral TAVR: a comparative analysis of bicuspid and tricuspid aortic valves
- 1Department of Cardiovascular Surgery, Fujian Provincial Center for Cardiovascular Medicine, Union Hospital, Fujian Medical University , ,
Abstract
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.
Related
- From maturation to degeneration: Distinct biological trajectories in bicuspid and tricuspid aortopathy
- Invasive Complications and Infection-Related Reconstruction in Bicuspid Versus Tricuspid Native Aortic Valve Endocarditis: A 12-Year Surgical Cohort Study
- Association of left atrial strain and stiffness index with ascending aortic dilatation in patients with bicuspid aortic valve
- Transcatheter aortic valve replacement in bicuspid versus tricuspid aortic valves among patients with mixed aortic valve disease
- Traumatic transfemoral bowel evisceration following bull horn injury: a case report and review of literature
BibTeX
@article{xu2026temporal,
title = {{Temporal changes in dilated ascending aorta after transfemoral TAVR: a comparative analysis of bicuspid and tricuspid aortic valves}},
author = {Qichen Xu and Zheng Xu and Xiaofu Dai and Liangwan Chen and Zhiqin Lin},
journal = {Frontiers in cardiovascular medicine},
year = {2026},
month = oct,
doi = {10.3389/fcvm.2026.1878963},
url = {https://europepmc.org/article/PMC/PMC13690726},
note = {CC BY},
}
RIS
TY - JOUR
TI - Temporal changes in dilated ascending aorta after transfemoral TAVR: a comparative analysis of bicuspid and tricuspid aortic valves
AU - Qichen Xu
AU - Zheng Xu
AU - Xiaofu Dai
AU - Liangwan Chen
AU - Zhiqin Lin
PY - 2026
DA - 2026/10/09
JO - Frontiers in cardiovascular medicine
DO - 10.3389/fcvm.2026.1878963
UR - https://europepmc.org/article/PMC/PMC13690726
AB - 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.
SN - 2297-055X
ER -