Structural Changesofthe Right Fibrous Trigone as a Risk Factor for Conduction Disturbance After Transcatheter Aortic...

Area of Science:

• Cardiology
• Medical Imaging
• Cardiac Surgery

Background:

• The right fibrous trigone (RFT) is anatomically close to the His bundle and membranous septum.
• Structural changes in the RFT can lead to conduction disturbances post-transcatheter aortic valve implantation (TAVI).

Purpose of the Study:

• To investigate if imaging parameters of the RFT can predict the risk of conduction disturbance after TAVI.
• To evaluate the association between RFT density and new-onset conduction disturbances.

Main Methods:

• Retrospective analysis of 209 patients undergoing transfemoral TAVI.
• Pre-procedure computed tomography (CT) was used to evaluate RFT alterations.
• Patients were grouped by valve type: self-expanding and balloon-expandable.

Main Results:

• Conduction disturbance occurred in 35.8% of patients.
• Optimal RFT density cut-offs for predicting disturbance were -6 HU (SEV) and -16 HU (BEV).
• High RFT density was an independent predictor of conduction disturbance for both valve types. Shorter membranous septum length and greater implantation depth were also associated with higher incidence.

Conclusions:

• Increased RFT density is independently associated with conduction disturbance post-TAVI.
• Pre-procedure CT evaluation of RFT density can aid in predicting new-onset conduction disturbance.