Usefulness of membranous septum length in the prediction of major conduction disturbances in patients undergoing transcatheter aortic valve replacement with different devices.
Journal
Kardiologia polska
ISSN: 1897-4279
Titre abrégé: Kardiol Pol
Pays: Poland
ID NLM: 0376352
Informations de publication
Date de publication:
23 10 2020
23 10 2020
Historique:
pubmed:
1
8
2020
medline:
10
4
2021
entrez:
1
8
2020
Statut:
ppublish
Résumé
Conduction disturbances (CD) are one of the most common adverse events after transcatheter aortic valve replacement (TAVR), and seem to be dependent on the device used as well as anatomical factors. The aim of this study was to evaluate whether the length of the membranous septum (MS) could provide useful information about the risk of CD and to examine the impact of the MS on CD after TAVR using different devices. This study included 140 patients undergoing TAVR with a balloon‑expandable valve or self‑‑expanding valve. The length of the MS was assessed by preoperative computed tomography. ΔMSID was calculated as the length of the MS minus implantation depth. A total of 24 patients (17%) received a permanent pacemaker (PPM), 53 (38%) developed new‑‑onset left bundle‑branch block (LBBB) following TAVR. The MS length was shown to be the strongest independent predictor of new‑onset LBBB (odds ratio [OR], 3.05; 95% CI, 1.96-4.77; P <0.001) and PPM implantation (OR, 3.76; 95% CI, 2.01-7.06; P <0.001). ΔMSID was also inversely associated with the development of LBBB and the need for PPM. In a head‑to‑head comparison, ΔMSID values were found to be statistically lower in the self‑expanding valve group (-0.8 mm vs 0.7 mm; P <0.001). A short MS and ΔMSID with a negative value increase the risk of CD. Assessment of the MS length prior to TAVR might serve as an additional tool to guide clinical decision‑making and appropriate device selection to reduce the the risk of CD.
Sections du résumé
BACKGROUND
Conduction disturbances (CD) are one of the most common adverse events after transcatheter aortic valve replacement (TAVR), and seem to be dependent on the device used as well as anatomical factors.
AIMS
The aim of this study was to evaluate whether the length of the membranous septum (MS) could provide useful information about the risk of CD and to examine the impact of the MS on CD after TAVR using different devices.
METHODS
This study included 140 patients undergoing TAVR with a balloon‑expandable valve or self‑‑expanding valve. The length of the MS was assessed by preoperative computed tomography. ΔMSID was calculated as the length of the MS minus implantation depth.
RESULTS
A total of 24 patients (17%) received a permanent pacemaker (PPM), 53 (38%) developed new‑‑onset left bundle‑branch block (LBBB) following TAVR. The MS length was shown to be the strongest independent predictor of new‑onset LBBB (odds ratio [OR], 3.05; 95% CI, 1.96-4.77; P <0.001) and PPM implantation (OR, 3.76; 95% CI, 2.01-7.06; P <0.001). ΔMSID was also inversely associated with the development of LBBB and the need for PPM. In a head‑to‑head comparison, ΔMSID values were found to be statistically lower in the self‑expanding valve group (-0.8 mm vs 0.7 mm; P <0.001).
CONCLUSIONS
A short MS and ΔMSID with a negative value increase the risk of CD. Assessment of the MS length prior to TAVR might serve as an additional tool to guide clinical decision‑making and appropriate device selection to reduce the the risk of CD.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM