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Predictors of Conduction Disturbances after Transcatheter Aortic Valve Implantation with Balloon-expandable Valve for Bicuspid Aortic Valve Stenosis
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  • Hirokazu Miyashita,
  • Noriaki Moriyama,
  • Futoshi Yamanaka,
  • Shigeru Saito,
  • Heidi Lehtola,
  • Jarkko Piuhola,
  • Matti Niemelä,
  • Mika Laine
Hirokazu Miyashita
Helsinki University Central Hospital

Corresponding Author:[email protected]

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Noriaki Moriyama
Shonan Kamakura General Hospital
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Futoshi Yamanaka
Shonan Kamakura General Hospital
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Shigeru Saito
Shonan Kamakura General Hospital
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Heidi Lehtola
Oulu University Hospital
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Jarkko Piuhola
Oulu University Hospital
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Matti Niemelä
Oulu University Hospital
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Mika Laine
Helsinki University Central Hospital
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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.
29 Nov 2021Submitted to Journal of Cardiovascular Electrophysiology
03 Dec 2021Submission Checks Completed
03 Dec 2021Assigned to Editor
05 Dec 2021Reviewer(s) Assigned
07 Mar 2022Review(s) Completed, Editorial Evaluation Pending
07 Mar 2022Editorial Decision: Revise Minor
20 Apr 20221st Revision Received
25 Apr 2022Submission Checks Completed
25 Apr 2022Assigned to Editor
25 Apr 2022Reviewer(s) Assigned
02 May 2022Review(s) Completed, Editorial Evaluation Pending
02 May 2022Editorial Decision: Accept
Jul 2022Published in Journal of Cardiovascular Electrophysiology volume 33 issue 7 on pages 1576-1586. 10.1111/jce.15525