PT  - JOURNAL ARTICLE
AU  - Justin T Tretter
AU  - Shumpei Mori
AU  - Robert H Anderson
AU  - Michael D Taylor
AU  - Nicholas Ollberding
AU  - Vien Truong
AU  - Joseph Choo
AU  - Dean Kereiakes
AU  - Wojciech Mazur
TI  - Anatomical predictors of conduction damage after transcatheter implantation of the aortic valve
AID  - 10.1136/openhrt-2018-000972
DP  - 2019 Apr 01
TA  - Open Heart
PG  - e000972
VI  - 6
IP  - 1
4099  - http://openheart.bmj.com/content/6/1/e000972.short
4100  - http://openheart.bmj.com/content/6/1/e000972.full
SO  - Open Heart2019 Apr 01; 6
AB  - 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.