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Left Ventricular Outflow Tract Morphology as a Predictor of Conductance Disturbances Following Transcatheter Aortic
Carolina Espejo-Paeres1, Luis Alfonso Marroquín-Donday1, Breda Hennessey1
1Clinico San Carlos University Hospital IdISSC Madrid Spain.
Insights
Tapered left ventricular outflow tract (LVOT) morphology increases the risk of permanent pacemaker implantation after transcatheter aortic valve replacement (TAVR). LVOT shape is a key factor in predicting pacemaker needs post-TAVR.
Area of Science:
- Cardiology
- Interventional Cardiology
- Cardiac Surgery
Background:
- Conduction disturbances are common complications after transcatheter aortic valve replacement (TAVR).
- Left ventricular outflow tract (LVOT) morphology's role in these complications requires further investigation.
Purpose of the Study:
- To investigate the association between left ventricular outflow tract (LVOT) morphology and the development of conduction disturbances after TAVR.
- To identify LVOT morphology as a predictor of permanent pacemaker implantation post-TAVR.
Main Methods:
- Retrospective analysis of 276 patients undergoing TAVR.
- Calculation of the ratio between LVOT area and aortic annulus area to classify LVOT morphology (tapered vs. non-tapered).
- Multivariable analysis to determine predictors of permanent pacemaker implantation.
Main Results:
- Tapered LVOT morphology (LVOT area/aortic annulus area ratio <0.9) was identified in 91 patients.
- Patients with tapered LVOT morphology had a significantly higher risk of permanent pacemaker implantation (HR, 2.6; P=0.014).
- Prior right bundle-branch block was also an independent predictor of permanent pacemaker implantation (HR, 4.3; P<0.001).
Conclusions:
- Tapered LVOT morphology is an independent predictor of permanent pacemaker implantation following TAVR.
- LVOT morphology should be considered when selecting prosthesis size to mitigate conduction disturbances.
Background:
Conduction disturbances represent one of the most common complications following transcatheter aortic valve replacement (TAVR). We sought to investigate the role of left ventricular outflow tract (LVOT) morphology in the development of conduction disturbances following TAVR.
Methods And Results:
Consecutive patients who underwent TAVR in our center were included. The ratio between the LVOT area and the aortic annulus area was calculated. Patients were then divided into 2 groups on the basis of this ratio: group 1, which included patients with an LVOT area/aortic annulus area ratio <0.9; and group 2, which included patients with an LVOT area/aortic annulus area ratio ≥0.9. The primary end point was to assess the relationship between LVOT shape and the rate of permanent pacemaker implantation following TAVR. A multivariable analysis was performed to identify predictors of permanent pacemaker implantation following TAVR. From January 2018 to December 2020, 276 patients were included. Ninety-one patients with tapered LVOT morphology were assigned to group 1 and the rest (n=185 patients), tubular LVOT or flared LVOT shape, to group 2. The mean age was 81.5±5.7 years and 57% were women. After adjusting by confounding factors, tapered morphology of the LVOT and prior right bundle-branch block were found to be independent predictors of permanent pacemaker implantation (hazard ratio [HR], 2.6 [95% CI, 1.2-5.7]; P=0.014; and HR: 4.3 [95% CI 2.4-7.6], P<0.001); at a median follow-up time of 15.5 (interquartile range, 15) months.
Conclusions:
A tapered-LVOT morphology was associated with increased risk for permanent pacemaker implantation. LVOT morphology may be an additional factor to consider when choosing prosthesis size.
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