Interventions for valvular disease and heart failure - Mini focus on TAVI

Membranous septum morphology and risk of conduction abnormalities after transcatheter aortic valve implantation

EuroIntervention 2022;17:1061-1069. DOI: 10.4244/EIJ-D-21-00363

Troels Jørgensen
Troels Højsgaard Jørgensen1, MD, PhD; Nicolaj Hansson2, MD, PhD; Ole De Backer1,3, MD, PhD; Gintautas Bieliauskas1, MD; Christian Juhl Terkelsen2, MD, DMSc; Xi Wang1,4, MD; Jesper Møller Jensen2, MD, PhD; Evald Høj Christiansen2, MD, PhD; Nicolo Piazza5, MD, PhD; Jesper Hastrup Svendsen1,3, MD, DMSc; Bjarne Linde Nørgaard2, MD, PhD; Lars Søndergaard1,3, MD, DMSc
1. Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark; 2. Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark; 3. Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; 4. Department of Cardiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China; 5. Division of Cardiology, McGill University Health Center, Montreal, ON, Canada

Background: There are limited data on the association of membranous septum (MS) morphology and transcatheter heart valve (THV) implantation depth, and the development of new conduction abnormalities (CA) after transcatheter aortic valve implantation (TAVI).

Aims: The aim of this study was to describe the morphology of the MS and predict the risk of new CA after TAVI based on the MS morphology and THV implantation depth.

Methods: Based on preprocedural CT scans, the MS depth was measured for every 25% of the entire MS width in 272 TAVI patients without preprocedural bundle branch block (BBB) or pacemaker. Post-procedural CT scans for THV implantation depth assessment were available in 130 of these patients.

Results: The MS depth was a median of 2.5 mm (IQR 1.4-3.8) deeper at the posterior edge when compared to the anterior edge of the MS. New CA developed in 7.1% of patients in whom the THV did not cross the lower MS border at its anterior edge (3.6% with new BBB and high degree CA, respectively), in 18.8% of patients (15.6% with new BBB and 3.1% with new high-degree CA) where the THV overlapped the lower MS border by <2.5 mm and in 47.1% of patients (24.3% with new BBB and 22.9% with new high-degree CA) with THV overlap of the lower MS border by ≥2.5 mm.

Conclusions: The difference of the MS depth and THV implantation depth measured at the anterior edge of the MS predicted new CA after TAVI.

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