Objective Conduction damage following transcatheter aortic valve implantation (TAVI) remains common. Anatomical risk factors remain elusive. We assessed the impact of variability in the dimensions of the membranous septum and position of the aortic root on the occurrence of conduction damage following TAVI.
Methods The dimensions of the membranous septum, the rotational position of the aortic root correlating to variability in the central fibrous body width, and wedging of the aortic root were assessed on pre-TAVI CT datasets. The depth of implantation was measured from the final aortic angiogram. The variables were compared with the occurrence of both permanent pacemaker insertion (PPI) and left bundle branch block (LBBB) following TAVI.
Results Of 200 patients who met inclusion criteria (mean age = 81 years ± 7.7, 49% men), 20.5 % underwent PPI after TAVI. New LBBB occurred in 23.5%, 21.3 % of whom required PPI. Preprocedural right bundle branch block (OR = 7.00; CI 3.13 to 15.64), valve type (OR=2.35; CI 1.13 to 4.87), depth of implantation (OR=1.62; CI 1.01 to 2.61) and the difference between depth of implantation and the distance from the virtual basal ring to the inferior margin of the membranous septum (OR=0.61; CI 0.38 to 0.99) were all associated with PPI, with similar associations with LBBB. No gross anatomical variable alone was associated with conduction damage.
Conclusions Gross anatomical variation of the aortic root and its underlying support, including the membranous septum, were not associated with the occurrence of either PPI or new LBBB. Procedural characteristics associated with these adverse outcomes suggest that the depth of implantation and radial force of the bioprosthesis, regardless of gross anatomical variability, increase the risk for conduction damage.
- transcatheter aortic valve replacement
- transcatheter aortic valve implantation
- permanent pacemaker implantation
- heart block
- left bundle branch block
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Contributors JTT originated the concept of the work, performed the data gathering, wrote the original manuscript and made significant revisions leading to the final manuscript. SM helped originate the concept of the work and provided significant revisions leading to the final manuscript. RA provided significant revisions leading to the final version of the manuscript. MT supervised the data gathering and made significant revisions to the final manuscript. NJO performed the statistical analysis and made revisions to the statistical and results sections of the manuscript. VTT helped with some of the data gathering. JKC helped originate the concept of the work and provided revisions leading to the final manuscript. DJK provided significant revisions leading to the final manuscript. WM provided significant revisions leading to the final manuscript.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests DJK is on the scientific advisory board for and a consultant for Boston Scientific Corporation.
Patient consent for publication Not required
Provenance and peer review Not commissioned; externally peer reviewed.
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