TY - JOUR
T1 - Short membranous septum length in bicuspid aortic valve stenosis increases the risk of conduction disturbances
AU - Hamdan, Ashraf
AU - Nassar, Mithal
AU - Schwammenthal, Ehud
AU - Perlman, Gidon
AU - Arow, Ziad
AU - Lessick, Jonathan
AU - Kerner, Arthur
AU - Barsheshet, Alon
AU - Assa, Hana Vaknin
AU - Assali, Abid
AU - Aviv, Yaron
AU - Goitein, Orly
AU - Brodov, Yafim
AU - Codner, Pablo
AU - Orvin, Katia
AU - Biton, David
AU - Klein, Eyal
AU - Danenberg, Haim
AU - Finkelstein, Ariel
AU - Kornowski, Ran
N1 - Publisher Copyright:
© 2020 Society of Cardiovascular Computed Tomography
PY - 2021/7/1
Y1 - 2021/7/1
N2 - Background: Distinct anatomical features predispose bicuspid AS patients to conduction disturbances after TAVR. This study sought to evaluate whether the incidence of permanent pacemaker implantation (PPMI) and left bundle branch block (LBBB) in patients with bicuspid aortic stenosis (AS) following transcatheter aortic valve replacement (TAVR) is related to an anatomical association between bicuspid AS and short membranous septal (MS) length. Methods: Sixty-seven consecutive patients with bicuspid AS from a Bicuspid AS TAVR multicenter registry and 67 propensity-matched patients with tricuspid AS underwent computed tomography before TAVR. Results: MS length was significantly shorter in bicuspid AS compared with tricuspid AS (6.2 ± 2.5 mm vs. 8.4 ± 2.7 mm, respectively; p < 0.001). In patients with bicuspid AS, MS length and aortic valve calcification were the most powerful pre-procedural independent predictors of PPMI or LBBB (odds ratio [OR]: 1.38, 95% confidence interval [CI]: 1.15 to 1.55, p = 0.003 and OR: 1.92, 95% CI: 1.1 to 3.34, p = 0.022, respectively). When taking into account pre- and post-procedural parameters, aortic valve calcification and the difference between MS length and implantation depth were the most powerful independent predictors of PPMI or LBBB in patients with bicuspid AS (OR: 1.82, 95%: 1.1 to 3.1, p = 0.027; OR: 1.25, 95% CI: 1.10 to 1.38, p = 0.003). Conclusion: MS length, which was significantly shorter in bicuspid AS compared with tricuspid AS, aortic valve calcification, and device implantation deeper than MS length predict PPMI or LBBB in bicuspid AS after TAVR.
AB - Background: Distinct anatomical features predispose bicuspid AS patients to conduction disturbances after TAVR. This study sought to evaluate whether the incidence of permanent pacemaker implantation (PPMI) and left bundle branch block (LBBB) in patients with bicuspid aortic stenosis (AS) following transcatheter aortic valve replacement (TAVR) is related to an anatomical association between bicuspid AS and short membranous septal (MS) length. Methods: Sixty-seven consecutive patients with bicuspid AS from a Bicuspid AS TAVR multicenter registry and 67 propensity-matched patients with tricuspid AS underwent computed tomography before TAVR. Results: MS length was significantly shorter in bicuspid AS compared with tricuspid AS (6.2 ± 2.5 mm vs. 8.4 ± 2.7 mm, respectively; p < 0.001). In patients with bicuspid AS, MS length and aortic valve calcification were the most powerful pre-procedural independent predictors of PPMI or LBBB (odds ratio [OR]: 1.38, 95% confidence interval [CI]: 1.15 to 1.55, p = 0.003 and OR: 1.92, 95% CI: 1.1 to 3.34, p = 0.022, respectively). When taking into account pre- and post-procedural parameters, aortic valve calcification and the difference between MS length and implantation depth were the most powerful independent predictors of PPMI or LBBB in patients with bicuspid AS (OR: 1.82, 95%: 1.1 to 3.1, p = 0.027; OR: 1.25, 95% CI: 1.10 to 1.38, p = 0.003). Conclusion: MS length, which was significantly shorter in bicuspid AS compared with tricuspid AS, aortic valve calcification, and device implantation deeper than MS length predict PPMI or LBBB in bicuspid AS after TAVR.
KW - Bicuspid aortic stenosis
KW - CT
KW - Membranous septum
KW - Permanent pacemaker
KW - TAVR
UR - http://www.scopus.com/inward/record.url?scp=85095733905&partnerID=8YFLogxK
U2 - 10.1016/j.jcct.2020.10.002
DO - 10.1016/j.jcct.2020.10.002
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C2 - 33153946
AN - SCOPUS:85095733905
SN - 1934-5925
VL - 15
SP - 339
EP - 347
JO - Journal of Cardiovascular Computed Tomography
JF - Journal of Cardiovascular Computed Tomography
IS - 4
ER -