JTCVS Open. 2026 May 8;32:101856. doi: 10.1016/j.xjon.2026.101856. eCollection 2026 Aug.
ABSTRACT
OBJECTIVE: The study objective was to evaluate outcomes after aortic valve replacement in patients with large or extra-large annuli.
METHODS: We conducted a retrospective cohort study of adults undergoing isolated transcatheter aortic valve replacement or surgical aortic valve replacement from 2021 to 2025 at a single quaternary care center. Eligible patients had large (annular area ≥575 mm2 or perimeter ≥85 mm) or extra-large (annular area ≥683 mm2 or perimeter ≥94.2 mm) trileaflet aortic annuli on preprocedural computed tomography.
RESULTS: A total of 414 patients underwent aortic valve replacement, including 353 transcatheter aortic valve replacements and 61 surgical aortic valve replacements. The median age was 78.8 years (interquartile range, 73.4-83.8), and 20 patients (4.8%) were female. Extra-large annuli were present in 109 patients (26%). Transcatheter aortic valve replacement recipients were older (median 80.2 vs 68.0 years, P < .001) and had a higher burden of comorbidities, including heart failure, atrial fibrillation, diabetes, and prior myocardial infarction (all P < .001). Early 30-day mortality was low, occurring in 3 patients who received transcatheter aortic valve replacement (0.9%) and none of the patients who received surgical aortic valve replacement (0%, P = .470). Compared with an age- and sex-matched US population, patients who received surgical aortic valve replacement had numerically lower mortality (standardized mortality ratio, 0.29, 95% CI, 0.04-2.03), whereas patients who received transcatheter aortic valve replacement experienced higher-than-expected mortality (standardized mortality ratio, 1.69, 95% CI, 1.35-2.11). Heart failure rehospitalization was significantly more frequent after transcatheter aortic valve replacement even after adjustment for baseline characteristics (hazard ratio, 5.09, 95% CI, 1.88-13.80, P = .001).
CONCLUSIONS: Aortic valve replacement in patients with large or extra-large annuli is safe, with low early mortality. Differences in long-term outcomes primarily reflect differences in baseline patient risk profiles rather than treatment strategy.
PMID:42604287 | PMC:PMC13477070 | DOI:10.1016/j.xjon.2026.101856