Ascending aortic elongation and correlative change in overall configuration of the proximal aorta in elderly patients with severe aortic stenosis.

Background: Configurational changes in the proximal aorta are relevant to the procedural difficulty of transcatheter aortic valve implantation (TAVI). Among several morphological changes involving the ascending aorta, elongation is characteristics of elderly patients with aortic stenosis and can compromise the success and safety of TAVI. However, the effect of ascending aortic elongation on the overall morphology of the proximal aorta has not been established.

Aims: Our primary purpose was to investigate the effect of ascending aortic elongation on structural changes in the proximal aorta in TAVI candidates.

Materials & Methods: In total, 121 consecutive patients with severe aortic stenosis (mean age, 84.5 ± 5.3 years; 69% women) who had undergone preprocedural computed tomography before TAVI were enrolled. We examined the structural anatomy of the proximal aorta in detail, focusing on its elongation, dilatation, tilting, rotation, and wedging.

Results: The mean length of the ascending aorta was 68.0 ± 9.2 mm, and the length was significantly correlated with dilatation (R = .278, p = .002), rightward tilting (R = .437, p < .001), clockwise rotation (R = .228, p = .018), and deep wedging (R = -.366, p < .001) of the proximal aorta. Elongation of the ascending aorta was correlated with dilatation, rightward tilting, clockwise rotation, and deep wedging of the proximal aorta in an elderly population with severe aortic stenosis.

Discussion: Appreciation of the clinical anatomy around the proximal aorta is required for clinicians involved in TAVI to estimate the procedural difficulty.

Conclusion: Elongation of the ascending aorta was associated with dilatation, rightward tilting, clockwise rotation, and deep wedging of the proximal aorta.