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Updated: Sep 28, 2025
Upper-extremity Approach for Secondary Access in Transfemoral Transcatheter Aortic Valve Implantation
Published on: August 8, 2025
Preprocedural and procedural variables that predict new-onset conduction disturbances after transcatheter aortic
Wongsaput Boonyakiatwattana1, Adisak Maneesai1, Vithaya Chaithiraphan2
1Division of Cardiology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Road, Bangkoknoi, Bangkok, 10700, Thailand.
Insights
New conduction disturbances after transcatheter aortic valve replacement (TAVR) are common. A membranous septum length ≤ 6.43 mm and a delta MSID < 0 mm are key predictors, with delta MSID < 0 mm being the only modifiable risk factor.
Area of Science:
- Cardiology
- Interventional Cardiology
- Cardiac Electrophysiology
Background:
- Conduction disturbances are a frequent complication following transcatheter aortic valve replacement (TAVR).
- Identifying predictors of these disturbances is crucial for improving patient outcomes.
- This study aimed to identify preprocedural and procedural variables associated with new-onset conduction disturbances post-TAVR.
Purpose of the Study:
- To investigate preprocedural and procedural factors predicting new-onset conduction disturbances after TAVR.
- To determine the optimal cutoff value for the difference between membranous septum length and implantation depth (∆MSID) in predicting conduction disturbances.
Main Methods:
- Retrospective analysis of 124 TAVR patients.
- Data collected included clinical, electrocardiographic, and preprocedural imaging (membranous septum length).
- Procedural variables, including implantation depth, were analyzed using multivariate logistic regression and ROC curve analysis.
Main Results:
- 28.2% of patients developed conduction disturbances (CD), with one-third requiring pacemaker implantation.
- Independent predictors of CD identified were membranous septum length ≤ 6.43 mm (aOR 9.54) and ∆MSID < 0 mm (aOR 10.77).
- The optimal ∆MSID cutoff value for predicting CD was < 0 mm, with an AuROC of 0.896.
Conclusions:
- Membranous septum length ≤ 6.43 mm and ∆MSID < 0 mm are independent predictors of conduction disturbances post-TAVR.
- ∆MSID < 0 mm is the strongest and only modifiable predictor.
- Expanding CD criteria may help identify a broader spectrum of TAVR-related conduction injury.
Background:
Conduction disturbances are a common complication after transcatheter aortic valve replacement (TAVR). The aim of this study was to investigate the preprocedural and procedural variables that predict new-onset conduction disturbances post-TAVR (hereafter CD/CDs).
Methods:
Consecutive patients who underwent TAVR during December 2009-March 2021 at the Faculty of Medicine Siriraj Hospital, Mahidol University-Thailand's largest national tertiary referral center-were enrolled. Patients with prior implantation of a cardiac device, periprocedural death, or unsuccessful procedure were excluded. Clinical and electrocardiographic data, preprocedural imaging, including membranous septum (MS) length, and procedural variables, including implantation depth (ID), were analyzed. CD was defined as new left or right bundle branch block, significant intraventricular conduction disturbance with QRS interval ≥ 120 ms, new high-grade atrioventricular block, or complete heart block. Multivariate binary logistic analysis and receiver operating characteristic (ROC) curve analysis were used to identify independent predictors and the optimal ∆MSID (difference between the MS length and ID) cutoff value, respectively.
Results:
A total of 124 TAVR patients (mean age: 84.3 ± 6.3 years, 62.1% female) were included. The mean Society of Thoracic Surgeons score was 7.3%, and 85% of patients received a balloon expandable transcatheter heart valve. Thirty-five patients (28.2%) experienced a CD, and one-third of those required pacemaker implantation. The significant preprocedural and procedural factors identified from univariate analysis included intraventricular conduction delay, mitral annular calcification, MS length ≤ 6.43 mm, self-expanding device, small left ventricular cavity, and ID ≥ 6 mm. Multivariate analysis revealed MS length ≤ 6.43 mm (adjusted odds ratio [aOR] 9.54; 95% CI 2.56-35.47; p = 0.001) and ∆MSID < 0 mm (adjusted odds ratio [aOR] 10.77; 95% CI 2.86-40.62; p = < 0.001) to be independent predictors of CD. The optimal ∆MSID cutoff value for predicting conduction disturbances was less than 0 mm (area under the receiver operating characteristic curve [AuROC]: 0.896).
Conclusion:
This study identified MS length ≤ 6.43 mm and ∆MSID < 0 mm as independent predictors of CDs. ∆MSID < 0 was the strongest and only modifiable predictor. Importantly, we expanded the CD criteria to cover all spectrum of TAVR-related conduction injury to lower the threshold of this sole modifiable risk. The optimal ∆MSID cutoff value was < 0 mm.
Trial Registration:
TCTR, TCTR20210818002. Registered 17 August 2021-Retrospectively registered, http://www.thaiclinicaltrials.org/show/TCTR 20210818002.
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