Temporal changes in dilated ascending aorta after transfemoral TAVR: a comparative analysis of bicuspid and tricuspid aortic valves

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.