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Corresponding Author

Ahmed Mohamed ELMeanawy

Document Type

Original Article

Abstract

Background: Transcatheter aortic valve implantation (TAVI) has transformed the management of elderly aortic stenosis patients (AS). However, conduction disturbances post-TAVI remain a concern.

Objective: To explore the influence of left ventricular outflow tract (LVOT) anatomical and morphological characteristics assessed by cardiac CT on the progression of conduction disturbances after TAVI.

Methods: This prospective observational study recruited 60 symptomatic severe AS patients scheduled for trans-femoral TAVI. Pre-procedural cardiac CT evaluated various LVOT morphological characteristics. Pre- and post-operative ECGs were conducted, and procedural details were recorded, including implantation depth, balloon pre/post-dilation, and transcatheter heart valve (THV) oversizing.

Results: Patients with a composite endpoint of new left bundle branch block at discharge or permanent pacemaker placement exhibited significantly lower weight than those without the endpoint (77 kg ±11 vs. 88 kg ±16, respectively, p = 0.009). Flared LVOT anatomy was less common in patients with the composite endpoint (10.5%) versus those without (37.5%) (p = 0.033). Multivariate analysis revealed weight (OR = 0.938, 95% CI = 0.884–0.996, p = 0.036) and implantation depth (OR = 1.976, 95% CI = 1.108–3.523, p = 0.021) as significant predictors of the composite endpoint.

Conclusion: Weight and implantation depth are significant predictors of post-TAVI conduction disturbances. Additionally, while not reaching statistical significance, the Euroscore II and flared anatomy trended towards being a potential predictor, showing the need for further investigation into their role in post-TAVI conduction disturbances.

Keywords

Left Ventricular Outflow Tract; Anatomy; Conduction Disturbances; Transcatheter Aortic Valve Implantation

Subject Area

Cardiovascular

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