The Predictors of Conduction Disturbances Following Transcatheter Aortic Valve Replacement in Patients With Bicuspid Aortic Valve: A Multicenter Study

Objective: To evaluate the predictors of new-onset conduction disturbances in bicuspid aortic valve patients using self-expanding valve and identify modifiable technical factors.Background: New-onset conduction disturbances (NOCDs), including complete left bundle branch block and high-grade atrioven...

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Autores principales:	Yuchao Guo, Dao Zhou, Mengqiu Dang, Yuxing He, Shenwei Zhang, Jun Fang, Shili Wu, Qiong Huang, Lianglong Chen, Yiqiang Yuan, Jiaqi Fan, Hasan Jilaihawi, Xianbao Liu, Jian'an Wang
Formato:	article
Lenguaje:	EN
Publicado:	Frontiers Media S.A. 2021
Materias:	bicuspid aortic stenosis conduction disturbances TAVR–transcatheter aortic valve replacement membranous septum oversizing ratio Diseases of the circulatory (Cardiovascular) system RC666-701
Acceso en línea:	https://doaj.org/article/9dc8e6a3f0e44f8995ab297753ac17fa
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spelling	oai:doaj.org-article:9dc8e6a3f0e44f8995ab297753ac17fa2021-12-01T13:59:13ZThe Predictors of Conduction Disturbances Following Transcatheter Aortic Valve Replacement in Patients With Bicuspid Aortic Valve: A Multicenter Study2297-055X10.3389/fcvm.2021.757190https://doaj.org/article/9dc8e6a3f0e44f8995ab297753ac17fa2021-11-01T00:00:00Zhttps://www.frontiersin.org/articles/10.3389/fcvm.2021.757190/fullhttps://doaj.org/toc/2297-055XObjective: To evaluate the predictors of new-onset conduction disturbances in bicuspid aortic valve patients using self-expanding valve and identify modifiable technical factors.Background: New-onset conduction disturbances (NOCDs), including complete left bundle branch block and high-grade atrioventricular block, remain the most common complication after transcatheter aortic valve replacement (TAVR).Methods: A total of 209 consecutive bicuspid patients who underwent self-expanding TAVR in 5 centers in China were enrolled from February 2016 to September 2020. The optimal cut-offs in this study were generated from receiver operator characteristic curve analyses. The infra-annular and coronal membranous septum (MS) length was measured in preoperative computed tomography. MSID was calculated by subtracting implantation depth measure on postoperative computed tomography from infra-annular MS or coronal MS length.Results: Forty-two (20.1%) patients developed complete left bundle branch block and 21 (10.0%) patients developed high-grade atrioventricular block after TAVR, while 61 (29.2%) patients developed NOCDs. Coronal MS <4.9 mm (OR: 3.08, 95% CI: 1.63–5.82, p = 0.001) or infra-annular MS <3.7 mm (OR: 2.18, 95% CI: 1.04–4.56, p = 0.038) and left ventricular outflow tract perimeter <66.8 mm (OR: 4.95 95% CI: 1.59–15.45, p = 0.006) were powerful predictors of NOCDs. The multivariate model including age >73 years (OR: 2.26, 95% CI: 1.17–4.36, p = 0.015), Δcoronal MSID <1.8 mm (OR: 7.87, 95% CI: 2.84–21.77, p < 0.001) and prosthesis oversizing ratio on left ventricular outflow tract >3.2% (OR: 3.42, 95% CI: 1.74–6.72, p < 0.001) showed best predictive value of NOCDs, with c-statistic = 0.768 (95% CI: 0.699–0.837, p < 0.001). The incidence of NOCDs was much lower (7.5 vs. 55.2%, p < 0.001) in patients without Δcoronal MSID <1.8 mm and prosthesis oversizing ratio on left ventricular outflow tract >3.2% compared with patients who had these two risk factors.Conclusion: The risk of NOCDs in bicuspid aortic stenosis patients could be evaluated based on MS length and prosthesis oversizing ratio. Implantation depth guided by MS length and reducing the oversizing ratio might be a feasible strategy for heavily calcified bicuspid patients with short MS.Yuchao GuoDao ZhouMengqiu DangYuxing HeShenwei ZhangJun FangShili WuQiong HuangLianglong ChenYiqiang YuanJiaqi FanHasan JilaihawiXianbao LiuJian'an WangFrontiers Media S.A.articlebicuspid aortic stenosisconduction disturbancesTAVR–transcatheter aortic valve replacementmembranous septumoversizing ratioDiseases of the circulatory (Cardiovascular) systemRC666-701ENFrontiers in Cardiovascular Medicine, Vol 8 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	bicuspid aortic stenosis conduction disturbances TAVR–transcatheter aortic valve replacement membranous septum oversizing ratio Diseases of the circulatory (Cardiovascular) system RC666-701
spellingShingle	bicuspid aortic stenosis conduction disturbances TAVR–transcatheter aortic valve replacement membranous septum oversizing ratio Diseases of the circulatory (Cardiovascular) system RC666-701 Yuchao Guo Dao Zhou Mengqiu Dang Yuxing He Shenwei Zhang Jun Fang Shili Wu Qiong Huang Lianglong Chen Yiqiang Yuan Jiaqi Fan Hasan Jilaihawi Xianbao Liu Jian'an Wang The Predictors of Conduction Disturbances Following Transcatheter Aortic Valve Replacement in Patients With Bicuspid Aortic Valve: A Multicenter Study
description	Objective: To evaluate the predictors of new-onset conduction disturbances in bicuspid aortic valve patients using self-expanding valve and identify modifiable technical factors.Background: New-onset conduction disturbances (NOCDs), including complete left bundle branch block and high-grade atrioventricular block, remain the most common complication after transcatheter aortic valve replacement (TAVR).Methods: A total of 209 consecutive bicuspid patients who underwent self-expanding TAVR in 5 centers in China were enrolled from February 2016 to September 2020. The optimal cut-offs in this study were generated from receiver operator characteristic curve analyses. The infra-annular and coronal membranous septum (MS) length was measured in preoperative computed tomography. MSID was calculated by subtracting implantation depth measure on postoperative computed tomography from infra-annular MS or coronal MS length.Results: Forty-two (20.1%) patients developed complete left bundle branch block and 21 (10.0%) patients developed high-grade atrioventricular block after TAVR, while 61 (29.2%) patients developed NOCDs. Coronal MS <4.9 mm (OR: 3.08, 95% CI: 1.63–5.82, p = 0.001) or infra-annular MS <3.7 mm (OR: 2.18, 95% CI: 1.04–4.56, p = 0.038) and left ventricular outflow tract perimeter <66.8 mm (OR: 4.95 95% CI: 1.59–15.45, p = 0.006) were powerful predictors of NOCDs. The multivariate model including age >73 years (OR: 2.26, 95% CI: 1.17–4.36, p = 0.015), Δcoronal MSID <1.8 mm (OR: 7.87, 95% CI: 2.84–21.77, p < 0.001) and prosthesis oversizing ratio on left ventricular outflow tract >3.2% (OR: 3.42, 95% CI: 1.74–6.72, p < 0.001) showed best predictive value of NOCDs, with c-statistic = 0.768 (95% CI: 0.699–0.837, p < 0.001). The incidence of NOCDs was much lower (7.5 vs. 55.2%, p < 0.001) in patients without Δcoronal MSID <1.8 mm and prosthesis oversizing ratio on left ventricular outflow tract >3.2% compared with patients who had these two risk factors.Conclusion: The risk of NOCDs in bicuspid aortic stenosis patients could be evaluated based on MS length and prosthesis oversizing ratio. Implantation depth guided by MS length and reducing the oversizing ratio might be a feasible strategy for heavily calcified bicuspid patients with short MS.
format	article
author	Yuchao Guo Dao Zhou Mengqiu Dang Yuxing He Shenwei Zhang Jun Fang Shili Wu Qiong Huang Lianglong Chen Yiqiang Yuan Jiaqi Fan Hasan Jilaihawi Xianbao Liu Jian'an Wang
author_facet	Yuchao Guo Dao Zhou Mengqiu Dang Yuxing He Shenwei Zhang Jun Fang Shili Wu Qiong Huang Lianglong Chen Yiqiang Yuan Jiaqi Fan Hasan Jilaihawi Xianbao Liu Jian'an Wang
author_sort	Yuchao Guo
title	The Predictors of Conduction Disturbances Following Transcatheter Aortic Valve Replacement in Patients With Bicuspid Aortic Valve: A Multicenter Study
title_short	The Predictors of Conduction Disturbances Following Transcatheter Aortic Valve Replacement in Patients With Bicuspid Aortic Valve: A Multicenter Study
title_full	The Predictors of Conduction Disturbances Following Transcatheter Aortic Valve Replacement in Patients With Bicuspid Aortic Valve: A Multicenter Study
title_fullStr	The Predictors of Conduction Disturbances Following Transcatheter Aortic Valve Replacement in Patients With Bicuspid Aortic Valve: A Multicenter Study
title_full_unstemmed	The Predictors of Conduction Disturbances Following Transcatheter Aortic Valve Replacement in Patients With Bicuspid Aortic Valve: A Multicenter Study
title_sort	predictors of conduction disturbances following transcatheter aortic valve replacement in patients with bicuspid aortic valve: a multicenter study
publisher	Frontiers Media S.A.
publishDate	2021
url	https://doaj.org/article/9dc8e6a3f0e44f8995ab297753ac17fa
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The Predictors of Conduction Disturbances Following Transcatheter Aortic Valve Replacement in Patients With Bicuspid Aortic Valve: A Multicenter Study

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