Author + information
- Brett Oestreicha,b,
- Sergey Gurevicha,b,
- Mackenzi Mbaia,b,
- Rosemary Kellya,b,
- Stefan Bertoga,b,
- Selcuk Adabaga,b,
- Prabhjot Nijjara,b and
- Santiago Garciaa,b
Background: The lower end of the membranous septum (MS) represents an anatomic landmark for the emergence of the His Bundle into the left ventricle. Computed tomography (CT) assessment of the membranous septal anatomy prior to transcatheter aortic valve replacement (TAVR) may provide information about the risk of atrioventricular (AV) block.
Methods: 61 consecutive patients with severe aortic stenosis undergoing contrast-enhanced CT prior to TAVR with the Edwards Sapien 3 valve (Edwards Lifescience, Irvine, CA) were included. The aortic annular complex, aortic valve and membranous septum length were assessed in standard double oblique views.
Results: The mean age (±SD) of the population was 79 (9) years. Sixteen patients (26%) developed a new left bundle branch block, 5 (8%) developed a high-degree AV block (8%), and 11 (18%) required a new permanent pacemaker after TAVR. A total of 14 patients (23%) had calcium in the basal septum and the mean (±SD) length was 8.4 mm (4). Median (IQ range) MS length was 8.4 mm (6-9) and membranous septum-implantation depth (MS-ID) was 2.4 mm (-1.5-7). Among patients with calcium in the basal septum the incidence of any conduction abnormality was 38% versus 15% in patients without (p=0.04). MS length or MS-ID were not predictors of conduction abnormalities (p=NS) (Table).
Conclusions: Implantation depth and presence of calcium in basal septum on pre-procedure CT predict increased risk of AV conduction abnormalities and need for pacemaker after TAVR with Sapien 3.
Poster Hall, Hall C
Saturday, March 18, 2017, 3:45 p.m.-4:30 p.m.
Session Title: Interventional Cardiology: PCI and TAVR in Complex Patients
Abstract Category: 24. Interventional Cardiology: Mitral and Structural Heart Disease
Presentation Number: 1239-121
- 2017 American College of Cardiology Foundation