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Upper-extremity Approach for Secondary Access in Transfemoral Transcatheter Aortic Valve Implantation
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Periprocedural Predictors of New-Onset Conduction Abnormalities After Transcatheter Aortic Valve Replacement

Kensuke Matsushita1,2, Mohamad Kanso1, Mickael Ohana3

  • 1Université de Strasbourg, Pôle d'Activité Médico-Chirurgicale Cardio-Vasculaire, Nouvel Hôpital Civil, Centre Hospitalier Universitaire.

Circulation Journal : Official Journal of the Japanese Circulation Society
|September 4, 2020
PubMed

Insights

New conduction abnormalities after TAVR increase mortality risk. Membranous septal length and implantation depth difference (∆MSID) predict these events, guiding future TAVR procedures.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Medical Devices

Background:

  • New-onset conduction abnormalities (CAs) after transcatheter aortic valve replacement (TAVR) are linked to increased hospital readmissions and mortality.
  • Predictors for these CAs, including new-onset left bundle branch block (LBBB) and permanent pacemaker (PPM) implantation, are not well-established.

Purpose of the Study:

  • To identify clinical predictors of new-onset LBBB and new PPM implantation in patients undergoing TAVR.
  • To investigate the association between CAs and adverse clinical outcomes post-TAVR.

Main Methods:

  • A prospective registry enrolled 290 patients undergoing TAVR with SAPIEN 3 or Evolut R valves.
  • Computed tomography was used to assess membranous septal anatomy and implantation depth.
  • Multivariate analysis identified predictors of CAs and their association with clinical events.

Main Results:

  • Among 242 patients without pre-existing LBBB, 114 (47%) developed new-onset LBBB and/or required new PPM implantation.
  • A difference between membranous septal length and implantation depth (∆MSID) was the sole predictor for CAs with both valve types.
  • PR interval and ∆MSID were the only predictors in multivariate analysis. Patients with CAs had a significantly higher risk of adverse clinical events (HR: 2.10; P=0.004).

Conclusions:

  • Computed tomography assessment of membranous septal anatomy and implantation depth can predict CAs following TAVR with new-generation valves.
  • Further research is needed to determine if adjusting implantation depth can mitigate the risk of CAs and adverse outcomes.
Abstract

Keywords:
Implantation depthLeft bundle branch blockMembranous septumPacemakersTranscatheter aortic valve replacement

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