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, I² = 0 %) and aortic dissection (RR 3.55 95 %CI: 1.79–7.06, p = 0.0003, I² = 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, I² = 0 %) and 1-year (RR 0.79, 95 %CI: 0.51–1.23, p = 0.30, I² = 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, I² = 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.