DOI: 10.1097/re9.0000000000000030 ISSN: 3066-1250

Short-term and 3-year follow-up clinical outcomes after TAVI in patients with aortic valve disease, with or without ascending aortic dilation.

Haoyang Li, Yuehuan Li, Jiawei Zhou, Zhang Chen, Haibo Zhang
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Background:

Patients with aortic valve disease with ascending aortic dilation (AAD) are not uncommon in clinical practice; however, currently, research on the prognosis of such patients after Transcatheter aortic valve implantation (TAVI) surgery in the Asian region is still insufficient. We aimed to compare short-term outcomes and 3-year follow-up clinical outcomes in patients with aortic valve disease who underwent TAVI with or without AAD.

Methods:

Patients with aortic valve disease who underwent TAVI at Beijing Anzhen Hospital between March 2017 and February 2024 were continuously enrolled and divided into dilated (maximum ascending aorta width ≥ 40 mm) and non-dilated groups. The short-term results were analyzed using logistic regression. Kaplan–Meier curves (K–M curves) illustrated the survival differences, and the log-rank test was used for evaluation. The independent risk factors affecting 3-year follow-up clinical outcomes were analyzed using a Cox regression model and restricted cubic spline (RCS) analysis. We used patient follow-up data to investigate the rate of progression of AAD.

Results:

A total of 440 patients were included in this study, including 185 in the AAD group and 255 in the non-AAD group. There was no statistically significant difference in perioperative complication rate or perioperative mortality between the two groups. The overlap of K–M curves was high in the two groups, and there was no difference in the log-rank test ( P = 0.521). RCS analysis revealed a nonlinear relationship between age and valve size for predicting all-cause mortality (nonlinear coefficients = 0.0489 and 0.0194). The median follow-up time was 1,051 days (484, 1,541) in the non-AAD group and 961 days (488, 1,672) in the AAD group. Follow-up data showed that there was no significant difference in the rate of progression of AAD between the two groups: 0.44 mm/year (0, 1.6) in the non-AAD group and 0.47 (−0.03, 1.6) in the AAD group, P = 0.861. During the follow-up process, no patients in the whole cohort developed ascending aortic dissection.

Conclusions:

This study found no significant difference in short-term outcomes or 3-year follow-up clinical outcomes between TAVI patients with AAD and those without, therefore, TAVI appears to be safe for patients with aortic valve disease accompanied with ascending aorta dilation. This study found that age, hospitalization length, and valve size may provide a new basis for the risk assessment of all-cause mortality in patients undergoing TAVI, suggesting that individualized management strategies should be developed for age, length of hospital stay, and valve size.

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