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Original research article
Anatomical predictors of conduction damage after transcatheter implantation of the aortic valve
  1. Justin T Tretter1,2,
  2. Shumpei Mori3,
  3. Robert H Anderson4,
  4. Michael D Taylor1,2,
  5. Nicholas Ollberding2,5,
  6. Vien Truong6,
  7. Joseph Choo6,
  8. Dean Kereiakes6 and
  9. Wojciech Mazur6
  1. 1Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
  2. 2Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
  3. 3Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
  4. 4Institute of Genetic Medicine, Newcastle University, Newcastle-upon-Tyne, UK
  5. 5Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
  6. 6Department of Ohio Heart and Vascular, The Christ Hospital and Lindner Center for Research and Education, Cincinnati, Ohio, USA
  1. Correspondence to Dr Justin T Tretter; justin.tretter{at}cchmc.org

Abstract

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

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

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Footnotes

  • 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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