Key result
Basal septal bulge links to ~30% higher odds of new-onset conduction disturbance after TAVR.
Why the study?
Basal septal bulge has been reported as a predictor of new-onset conduction disturbance after TAVR, but its impact according to the deployed valve position relative to membranous septum length remained unclear.
Does a basal septal bulge (>=3 mm) increase the risk of new-onset conduction disturbance according to valve implantation depth in patients undergoing transcatheter aortic valve replacement?
Observational (n=2,375)
Does a basal septal bulge (>=3 mm) increase the risk of new-onset conduction disturbance according to valve implantation depth in patients undergoing transcatheter aortic valve replacement?
A basal septal bulge >=3 mm significantly predicts new-onset conduction disturbance after TAVR, particularly when the valve is deployed below the membranous septum length, informing pre-procedural risk stratification and deployment depth strategy.
Basal septal bulge assessment may refine TAVR conduction risk stratification; extends prior associations to deployment depth but should not yet change practice.
Background/Introduction New-onset conduction disturbance (CD) is a common complication of transcatheter aortic valve replacement (TAVR). Recently, basal septal bulge (BSB) has been reported as a predictor of new-onset CD. However, the impact of BSB on new-onset CD according to the position of deployed valve remains unclear. Purpose This study investigated the impact of BSB on new-onset CD after TAVR according to the implantation depth (ID) relative to membranous septum (MS) length. Methods We retrospectively analyzed 2375 patients who underwent TAVR. New-onset CD was defined as 30-day new permanent pacemaker implantation or new left bundle branch block lasting until discharge. The study endpoints were the predictors of new-onset CD and the impact of BSB on new-onset CD. Results The incidence of new-onset CD was 14.2%. Multivariate analysis showed that complete right bundle branch block (OR: 1.85; 95% CI: 1.36–2.51), MS length <2 mm (OR: 1.48; 95% CI: 1.17–1.87), and BSB ≥3 mm (OR: 1.30; 95% CI: 1.03–1.64) were independent baseline predictors of new-onset CD. Use of self-expanding valve (OR: 1.65; 95% CI: 1.26–2.16), ID >MS length (OR: 2.57; 95% CI: 1.97–3.35), and post-dilatation (OR: 1.61; 95% CI: 1.03–2.53) were the independent procedural predictors. In the group of ID >MS length, BSB ≥3 mm was the significant predictor of new-onset CD (OR: 1.38; 95% CI: 1.04–1.82). Conclusions BSB was significantly associated with new-onset CD especially in the group of low deployment. These findings might be beneficial for peri-procedural management and TAVR strategy.
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Sugiyama et al. (2026) conducted an observational in Aortic stenosis undergoing transcatheter aortic valve replacement (TAVR) (n=2,375). Basal septal bulge (BSB) ≥3 mm vs. BSB <3 mm was evaluated on New-onset conduction disturbance (30-day new permanent pacemaker implantation or new left bundle branch block lasting until discharge) (OR 1.30, 95% CI 1.03-1.64). Basal septal bulge ≥3 mm independently predicted new-onset conduction disturbance after TAVR (OR 1.30; 95% CI 1.03-1.64), especially with low valve deployment (OR 1.38; 95% CI 1.04-1.82).
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