Short membranous septum length in bicuspid aortic valve stenosis increases the risk of conduction disturbances

Ashraf Hamdan, Mithal Nassar, Ehud Schwammenthal, Gidon Perlman, Ziad Arow, Jonathan Lessick, Arthur Kerner, Alon Barsheshet, Hana Vaknin Assa, Abid Assali, Yaron Aviv, Orly Goitein, Yafim Brodov, Pablo Codner, Katia Orvin, David Biton, Eyal Klein, Haim Danenberg, Ariel Finkelstein, Ran Kornowski

Research output: Contribution to journalArticlepeer-review

Abstract

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.

Original languageEnglish
Pages (from-to)339-347
Number of pages9
JournalJournal of Cardiovascular Computed Tomography
Volume15
Issue number4
DOIs
StatePublished - 1 Jul 2021

Keywords

  • Bicuspid aortic stenosis
  • CT
  • Membranous septum
  • Permanent pacemaker
  • TAVR

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