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Predictors of post-TAVI conduction abnormalities in patients with bicuspid aortic valves

Esposito, Giulia; Kumar, Niraj; Pugliese, Francesca; Sayers, Max; Chow, Anthony Wc; Kennon, Simon; Ozkor, Mick; ... Patel, Kush P; + view all (2022) Predictors of post-TAVI conduction abnormalities in patients with bicuspid aortic valves. Open Heart , 9 (2) , Article e001995. 10.1136/openhrt-2022-001995. Green open access

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Abstract

OBJECTIVES: This study evaluates predictors of conduction abnormalities (CA) following transcatheter aortic valve implantation (TAVI) in patients with bicuspid aortic valves (BAV). BACKGROUND: TAVI is associated with CA that commonly necessitate a permanent pacemaker. Predictors of CA are well established among patients with tricuspid aortic valves but not in those with BAV. METHODS: This is a single-centre, retrospective, observational study of patients with BAV treated with TAVI. Pre-TAVI ECG and CT scans and procedural characteristics were evaluated in 58 patients with BAV. CA were defined as a composite of high-degree atrioventricular block, new left bundle branch block with a QRS >150 ms or PR >240 ms and right bundle branch block with new PR prolongation or change in axis. Predictors of CA were identified using regression analysis and optimum cut-off values determined using area under the receiver operating characteristic curve analysis. RESULTS: CA occurred in 35% of patients. Bioprosthesis implantation depth, the difference between membranous septum (MS) length and implantation depth (δMSID) and device landing zone (DLZ) calcification adjacent to the MS were identified as univariate predictors of CA. The optimum cut-off for δMSID was 1.25 mm. Using this cut-off, low δMSID and DLZ calcification adjacent to MS predicted CA, adjusted OR 8.79, 95% CI 1.88 to 41.00; p=0.01. Eccentricity of the aortic valve annulus, type of BAV and valve calcium quantity and distribution did not predict CA. CONCLUSIONS: In BAV patients undergoing TAVI, short δMSID and DLZ calcification adjacent to MS are associated with an increased risk of CA.

Type: Article
Title: Predictors of post-TAVI conduction abnormalities in patients with bicuspid aortic valves
Location: England
Open access status: An open access version is available from UCL Discovery
DOI: 10.1136/openhrt-2022-001995
Publisher version: http://dx.doi.org/10.1136/openhrt-2022-001995
Language: English
Additional information: This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.
Keywords: Aortic Valve Stenosis, Congenital Abnormalities, Pacemaker, Artificial, Transcatheter Aortic Valve Replacement, Bicuspid Aortic Valve Disease, Bundle-Branch Block, Calcinosis, Humans, Retrospective Studies, Transcatheter Aortic Valve Replacement
UCL classification: UCL
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute of Cardiovascular Science > Childrens Cardiovascular Disease
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute of Cardiovascular Science
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
URI: https://discovery.ucl.ac.uk/id/eprint/10152045
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