Key result
Short membranous septum on CT linked to ~14-fold greater PPMI or LBBB risk after SAVR.
Why the study?
Membranous septum length measured by cardiac CT predicts PPMI and new LBBB after TAVR, but its predictive value in patients undergoing SAVR is unknown.
Does short membranous septum length measured by pre-procedural CT predict new permanent pacemaker implantation or new left bundle branch block in patients undergoing surgical aortic valve replacement?
Cohort (n=126)
No
Does short membranous septum length measured by pre-procedural CT predict new permanent pacemaker implantation or new left bundle branch block in patients undergoing surgical aortic valve replacement?
Short membranous septum length (<1.5 mm) measured by preoperative cardiac CT is a strong independent predictor of new permanent pacemaker implantation or left bundle branch block after surgical aortic valve replacement.
Answers are grounded in this paper and cite their sources.
Short MS length may aid conduction risk stratification before SAVR; hypothesis-generating and requires prospective validation before practice change.
PURPOSE The membranous septum (MS) length measured by cardiac computed tomography (CT) is useful for the prediction of permanent pacemaker implantation (PPMI) and new left bundle branch block (LBBB) after transcatheter aortic valve replacement. However, its predictive value for patients undergoing surgical aortic valve replacement (SAVR) is unknown. Methods A total of 2531 consecutive patients were registered in the institutional Society of Thoracic Surgeons database between July 2017 and June 2020. Excluding non-SAVR procedures, prior pacemaker/implantable cardioverter defibrillator, prior SAVR, no pre-procedural CT assessment and suboptimal CT imaging. Results A total of 126 SAVR with pre-procedural CT assessment were analyzed. Bicuspid aortic valve morphology was confirmed on CT in 59.5% of patients. There were three new PPMIs and five new LBBBs observed after SAVR at the time of discharge. In-hospital mortality was 0.8%. Low left ventricular ejection fraction (< 50%), left ventricular (LV) mass index > 120 g/m 2 , large right coronary artery height and MS length < 1.5 mm predicted new PPMI/LBBB. Multivariate analysis showed LV mass index > 120 g/m 2 (odds ratio: 9.165; 95% confidence interval: 1.644-51.080; p = 0.011) and MS length < 1.5 mm (odds ratio: 14.449; 95% confidence interval: 1.632-127.954; p = 0.016) were independent predictors for new PPMI/LBBB. Conclusion Short MS length on preoperative cardiac CT is a powerful and novel predictor for the risk of new PPMI/LBBB after SAVR. Special care should be taken in patients with short MS length to avoid suture-mediated trauma.
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Nakashima et al. (2022) conducted a cohort in Aortic valve disease requiring surgical aortic valve replacement (n=126). Short membranous septum length (< 1.5 mm) on preoperative CT vs. Membranous septum length ≥ 1.5 mm was evaluated on New permanent pacemaker implantation (PPMI) or new left bundle branch block (LBBB) at the time of discharge (OR 14.449, 95% CI 1.632-127.954, p=0.016). Short membranous septum length (< 1.5 mm) on preoperative cardiac CT independently predicted a significantly higher risk of new permanent pacemaker implantation or left bundle branch block after surgical aortic valve replacement (OR 14.449).
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