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.