Impact of basal septal bulge on conduction disturbance relative to valve position after transcatheter aortic valve replacement
Y Sugiyama, N Moriyama, D Sato, M Kai, H Miyashita, T Ochiai, K Shishido, M Jalanko, F Yamanaka, T Vahasilta, S Saito, M LaineAbstract
Background/Introduction
New-onset conduction disturbance (CD) is a common complication of transcatheter aortic valve replacement (TAVR). Recently, basal septal bulge (BSB) has been reported as a predictor of new-onset CD. However, the impact of BSB on new-onset CD according to the position of deployed valve remains unclear.
Purpose
This study investigated the impact of BSB on new-onset CD after TAVR according to the implantation depth (ID) relative to membranous septum (MS) length.
Methods
We retrospectively analyzed 2375 patients who underwent TAVR. New-onset CD was defined as 30-day new permanent pacemaker implantation or new left bundle branch block lasting until discharge. The study endpoints were the predictors of new-onset CD and the impact of BSB on new-onset CD.
Results
The incidence of new-onset CD was 14.2%. Multivariate analysis showed that complete right bundle branch block (OR: 1.85; 95% CI: 1.36–2.51), MS length <2 mm (OR: 1.48; 95% CI: 1.17–1.87), and BSB ≥3 mm (OR: 1.30; 95% CI: 1.03–1.64) were independent baseline predictors of new-onset CD. Use of self-expanding valve (OR: 1.65; 95% CI: 1.26–2.16), ID >MS length (OR: 2.57; 95% CI: 1.97–3.35), and post-dilatation (OR: 1.61; 95% CI: 1.03–2.53) were the independent procedural predictors. In the group of ID >MS length, BSB ≥3 mm was the significant predictor of new-onset CD (OR: 1.38; 95% CI: 1.04–1.82).
Conclusions
BSB was significantly associated with new-onset CD especially in the group of low deployment. These findings might be beneficial for peri-procedural management and TAVR strategy.