Importance of Preoperative Computed Tomography Assessment of the Membranous Septal Anatomy in Patients Undergoing Transcatheter Aortic Valve Replacement With a Balloon-Expandable Valve

Abstract

sistent on the association of CD with MS in patients with a balloon-expandable valve (BEV). 9,10 Therefore, we examined whether computed tomography (CT) assessment of the MS anatomy could provide useful information about the risk of CD, PPM implantation or CLBBB, following TAVR with BEV. Methods Study Population The study population comprised 132 consecutive patients with symptomatic severe AS who underwent TAVR at Kyoto Prefectural University of Medicine between February 2016 and July 2019; 26 patients were excluded for the following reasons: 13 did not have sufficient quality of CT T ranscatheter aortic valve replacement (TAVR) has become one of the best treatment options for patients with severe aortic stenosis (AS) and high or extreme surgical risk. 1-3 The periprocedural complication rate for TAVR has markedly decreased, 4 but cardiac conduction disturbance (CD) following TAVR, such as atrioventricular block (AVB) requiring permanent pacemaker (PPM) implantation or complete left-bundle-branch block (CLBBB), is a frequent complication. 5 This is because the atrioventricular node is continuous with the His bundle and pierces the membranous septum (MS), which is just below the left ventricular (LV) outflow tract. 6,7 A previous report showed that short MS length predicted PPM implantation after TAVR with a self-expandable valve (SEV). 8 However, results from 2 studies have been incon

Computed tomography‐derived membranous septum length as predictor of conduction abnormalities and permanent pacemaker implantation after TAVI: A meta‐analysis of observational studies

“…After excluding duplicates and noneligible studies, 18 studies 4,6,[15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30] met our eligibility criteria (Supporting Information: Figure 1). All the studies were nonrandomized and observational, while four studies were multicentric and five studies included matched populations (Table 1).…”

Preprocedural and procedural variables that predict new-onset conduction disturbances after transcatheter aortic valve replacement

“…Chen, et al reported an ∆MSID of 3.2 mm to be the optimal cutoff point for predicting a CD when using a self -expanding device [21]. For balloon expanding TAVR, mean ∆MSIDs of − 2.5 ± 2.4 mm [23], 0.5 ± 4 mm [24], and − 1.7 ± 1.5 mm [27] were reported in patients with PPMI or LBBB. Miki, et al reported that an ∆MSID cut-off value of -0.7 mm had an AuROC of 0.85, sensitivity of 0.78, and specificity of 0.82 (p < 0.001).…”

Evolution of high‐grade atrioventricular conduction disorders after transcatheter aortic valve implantation in patients who underwent implantation of a pacemaker with specific mode—that minimizes ventricular pacing—activated

“…Finally, we did not measure the membranous septum, which could be an interesting aspect, associated to the implantation height, to stratify the risk of conduction disorders after TAVI. 30 An ancillary analysis of STIM-TAVI (STIM-TAVI/MS) is currently running, in which we are analyzing membranous septum length and implantation height.…”