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Ratio of left ventricular outflow tract area to aortic annulus area and complete atrioventricular block after transcatheter aortic valve replacement for aortic stenosis.
Kikuchi, Shinnosuke; Minamimoto, Yugo; Matsushita, Kensuke; Cho, Tomoki; Terasaka, Kengo; Hanajima, Yohei; Nakahashi, Hidefumi; Gohbara, Masaomi; Kimura, Yuichiro; Yasuda, Shota; Okada, Kozo; Matsuzawa, Yasushi; Iwahashi, Noriaki; Kosuge, Masami; Ebina, Toshiaki; Morel, Olivier; Ohlmann, Patrick; Uchida, Keiji; Hibi, Kiyoshi.
Afiliação
  • Kikuchi S; Division of Cardiology, Yokohama City University Medical Center, Yokohama, Japan.
  • Minamimoto Y; Division of Cardiology, Yokohama City University Medical Center, Yokohama, Japan.
  • Matsushita K; Division of Cardiology, Yokohama City University Medical Center, Yokohama, Japan.
  • Cho T; Cardiovascular Center, Yokohama City University Medical Center, Yokohama, Japan.
  • Terasaka K; Division of Cardiology, Yokohama City University Medical Center, Yokohama, Japan.
  • Hanajima Y; Division of Cardiology, Yokohama City University Medical Center, Yokohama, Japan.
  • Nakahashi H; Division of Cardiology, Yokohama City University Medical Center, Yokohama, Japan.
  • Gohbara M; Division of Cardiology, Yokohama City University Medical Center, Yokohama, Japan.
  • Kimura Y; Division of Cardiology, Yokohama City University Medical Center, Yokohama, Japan.
  • Yasuda S; Cardiovascular Center, Yokohama City University Medical Center, Yokohama, Japan.
  • Okada K; Division of Cardiology, Yokohama City University Medical Center, Yokohama, Japan.
  • Matsuzawa Y; Division of Cardiology, Yokohama City University Medical Center, Yokohama, Japan.
  • Iwahashi N; Division of Cardiology, Yokohama City University Medical Center, Yokohama, Japan.
  • Kosuge M; Division of Cardiology, Yokohama City University Medical Center, Yokohama, Japan.
  • Ebina T; Division of Cardiology, Yokohama City University Medical Center, Yokohama, Japan.
  • Morel O; Université de Strasbourg, Pôle d'Activité Médico-Chirurgicale Cardio-Vasculaire, Nouvel Hôpital Civil, Centre Hospitalier Universitaire, 1 Place de L'Hôpital, 67091 Strasbourg, France.
  • Ohlmann P; Université de Strasbourg, Pôle d'Activité Médico-Chirurgicale Cardio-Vasculaire, Nouvel Hôpital Civil, Centre Hospitalier Universitaire, 1 Place de L'Hôpital, 67091 Strasbourg, France.
  • Uchida K; Cardiovascular Center, Yokohama City University Medical Center, Yokohama, Japan.
  • Hibi K; Division of Cardiology, Yokohama City University Medical Center, Yokohama, Japan; Department of Cardiology, Yokohama City University Graduate School of Medicine, Yokohama, Japan. Electronic address: hibikiyo@yokohama-cu.ac.jp.
Int J Cardiol ; 397: 131608, 2024 Feb 15.
Article em En | MEDLINE | ID: mdl-38030042
ABSTRACT

BACKGROUND:

Mechanical compression of cardiac conduction system by transcatheter heart valves leads to complete atrioventricular block (CAVB) after transcatheter aortic valve replacement (TAVR). Bulging of ventricular septum in the left ventricular outflow tract (LVOT) may be associated with greater compression of conduction system, leading to irreversible CAVB.

OBJECTIVE:

This study aimed to investigate the association of ventricular septal bulging with TAVR-related CAVB and permanent pacemaker implantation (PPI).

METHODS:

Among 294 consecutive patients with severe aortic stenosis who underwent TAVR between July 2017 and February 2023, 271 were included in the analysis. As a quantitative evaluation of bulging of the ventricular septum, the ratio of LVOT area to aortic annulus area (L/A ratio) was measured at the systolic phase of computed tomography images.

RESULTS:

TAVR-related CAVB occurred in 64 patients (23.6%). Twenty-eight patients (10.3%) required PPI. The optimal thresholds of L/A ratio for predicting TAVR-related CAVB and PPI were 1.0181 and 0.985, respectively. Patients with less than the cut-off values had higher rate of TAVR-related CAVB and PPI than those above (28.3% vs 13.1%, p = 0.0063; 14.7% vs 4.4%, p = 0.0077, respectively). A multivariate analysis showed that L/A ratio < 1.0181 was an independent predictor of TAVR-related CAVB (odds ratio [OR] 2.65, p = 0.011), in addition to prior right bundle branch block (OR 3.76, p = 0.0005), use of a self-expanding valve (OR 1.99, p = 0.030), and short membranous septum length (OR 0.96, p = 0.037). Only L/A ratio < 0.985 was independently associated with PPI (OR 3.70, p = 0.011).

CONCLUSION:

Low L/A ratio is a predictor of TAVR-related CAVB and PPI.
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Texto completo: 1 Base de dados: MEDLINE Assunto principal: Estenose da Valva Aórtica / Marca-Passo Artificial / Próteses Valvulares Cardíacas / Bloqueio Atrioventricular / Substituição da Valva Aórtica Transcateter Limite: Humans Idioma: En Ano de publicação: 2024 Tipo de documento: Article

Texto completo: 1 Base de dados: MEDLINE Assunto principal: Estenose da Valva Aórtica / Marca-Passo Artificial / Próteses Valvulares Cardíacas / Bloqueio Atrioventricular / Substituição da Valva Aórtica Transcateter Limite: Humans Idioma: En Ano de publicação: 2024 Tipo de documento: Article