Predictors of Conduction Disturbances after Transcatheter Aortic Valve
Implantation with Balloon-expandable Valve for Bicuspid Aortic Valve
Stenosis
Abstract
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.