Key result
Bicuspid TAVR links to ~60% more new conduction disturbances than tricuspid, predicted by severe LVOT calcification.
Why the study?
The predictors of new-onset conduction disturbance after TAVR with balloon-expandable valve in bicuspid aortic valve stenosis are not well known compared to tricuspid aortic valve stenosis.
Do implantation depth and membranous septum length predict new-onset conduction disturbances in patients with bicuspid aortic valve stenosis undergoing TAVR with a balloon-expandable valve?
Cohort (n=169)
Do implantation depth and membranous septum length predict new-onset conduction disturbances in patients with bicuspid aortic valve stenosis undergoing TAVR with a balloon-expandable valve?
In patients with bicuspid aortic valve stenosis undergoing TAVR with a balloon-expandable valve, severe LVOT calcification and the difference between implantation depth and membranous septum length are strong predictors of new-onset conduction disturbances.
Supports individualized TAVR planning in BAV; leaves open whether depth optimization reduces conduction disturbances.
Objective: The implantation depth and membranous septum (MS) length are established as the predictors of new-onset conduction disturbance (CD) after transcatheter aortic valve replacement (TAVR) for tricuspid aortic valve (TAV) stenosis. However, little is known about the predictors with bicuspid aortic valve (BAV). This study investigated the role of MS length and implantation depth in predicting CD following TAVR with a balloon-expandable valve in patients with BAV. Methods and results: This retrospective study analyzed 169 patients who underwent TAVR for BAV with balloon-expandable valve, and TAV cohort was established as a control group using propensity score (PS) matching. The primary endpoint was in-hospital new-onset CD (new-onset left bundle branch block or new permanent pacemaker implantation). New-onset CD developed in 37 patients (21.9%). Multivariate analysis revealed severe LVOT calcification (Odds ratio [OR]: 5.83, 95% confidence interval [CI]: 1.08 – 31.5, p = 0.0407) and implantation depth – MS length (OR: 1.30, 95% CI: 1.12 – 1.51, p = 0.0005) as the predictors of new-onset CD within BAV cohort. The matched comparison between BAV and TAV groups showed similar MS length (3.0 vs 3.2mm, p = 0.5307), but valves were implanted deeper in BAV than TAV group (3.9 vs 3.0mm, p < .0001). New-onset CD was more frequent in patients having BAV (22.3% vs 13.9%, p = 0.0458). Conclusion: The implantation depth - MS length, and severe LVOT calcification predicted new-onset CD following TAVR in BAV with balloon-expandable valve. High implantation technique could be considered to avoid new-onset CD in BAV anatomy.
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Miyashita et al. (2021) conducted a cohort in Bicuspid aortic valve stenosis (n=169). Bicuspid aortic valve (BAV) anatomy vs. Tricuspid aortic valve (TAV) anatomy was evaluated on In-hospital new-onset conduction disturbance (new-onset left bundle branch block or new permanent pacemaker implantation) (p=0.0458). New-onset conduction disturbance was more frequent after TAVR in bicuspid compared to tricuspid aortic valves (22.3% vs 13.9%, p=0.0458), and was predicted by severe LVOT calcification.
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