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Anatomical characteristics of the membranous septum are predictive of pacemaker requirement in patients undergoing transcatheter aortic valve replacement

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Abstract

Purpose

We aimed to study the characteristics of the membranous septum (MS) and its relationship with the aortic valve (AoV) and aortic annulus (AA) in patients who required PPM post-TAVR.

Methods

We performed a retrospective case–control study of 144 patients undergoing TAVR from 2016 to 2018. Thirty-four patients, requiring PPM implantation, were compared with 34 matched controls who did not require pacing. The total MS length, supra-annular MS (SA-MS) length, infra-annular MS (IA-MS) length, angle between the plane of the AA and MS (AA-MS), and degree of AoV calcifications (AVC) were obtained from preoperative CT. AoV prosthesis implantation depth was obtained from intra-operative fluoroscopy.

Results

There were no significant differences in valve type (self-expandable: 23 cases vs 25 controls, and balloon-expandable: 11 vs 9, p = 0.79), degree of AVC (0.65 cm3 vs 0.82 cm3, p = 0.62), or implantation depth (7.76 mm vs 7.28 mm, p = 0.83). Compared to controls, there was no difference in total MS length (6.68 mm vs 6.06 mm, p = 0.97), but the IA-MS was significantly shorter (3.64 mm vs 4.56 mm, p = 0.02) and the SA-MS was significantly longer (2.73 mm vs 1.67 mm, p = 0.02) in patients requiring PPM. Patients requiring PPM also had a larger AA-MS angle (103.5° vs 96.7°, p = 0.01).

Conclusion

The position of the MS with respect to the AA and MS distance below the annular plane were more closely associated with post-TAVR conduction abnormalities requiring PPM than the absolute length of the MS. Patients undergoing TAVR with such anatomy have a higher risk of requiring PPM and should be monitored for developing these complications.

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Availability of data and material

Raw data were generated at University of Maryland Medical Center. Derived data supporting findings of this study are available from the corresponding author (JN) on request.

This manuscript is not under consideration for publication elsewhere, its publication is approved by all authors and tacitly or explicitly by the responsible authorities where the work was carried out, and that, if accepted, it will not be published elsewhere in the same form, in English or in any other language, including electronically without the written consent of the copyright-holder. All authors have read and approved of the manuscript. No funding was required for this study.

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Acknowledgements

All authors made a substantial contribution to the study. The study was designed by Dr. Jonathan Na, Bryan Nixon, Dr. Jean Jeudy, and Dr. Alejandro Jimenez Restrepo. Radiographic CT data was analyzed by Bryan Nixon and Dr. Jean Jeudy. Demographic data was gathered by Dr. Jonathan Na, Dr. Paul Han, Dr. James Childress, Dr. Gregory Norcross, and Dr. Steven Liskov. Dr. Na, Bryan Nixon, and Dr. Jimenez Restrepo contributed to analysis and interpretation of data. Article was drafted by Dr. Na and Bryan Nixon and revisions were provided by Dr. Jimenez Restrepo. Dr. Jimenez Restrepo provided study oversight and final approval of article submitted. All authors have read the final article and have approved it for submission.

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Authors and Affiliations

  1. University of Maryland Medical Center, Baltimore, MD, USA

    Jonathan Na, James Childress, Paul Han, Gregory Norcross, Steven Liskov, Jean Jeudy & Alejandro Jimenez Restrepo

  2. University of Maryland School of Medicine, Baltimore, MD, USA

    Bryan Nixon

  3. Lankenau Medical Center, Wynnewood, PA , USA

    Steven Liskov

  4. Marshfield Clinic Health System, Marshfield, WI, USA

    Alejandro Jimenez Restrepo

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Correspondence to Jonathan Na.

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Na, J., Nixon, B., Childress, J. et al. Anatomical characteristics of the membranous septum are predictive of pacemaker requirement in patients undergoing transcatheter aortic valve replacement. J Interv Card Electrophysiol 63, 449–459 (2022). https://doi.org/10.1007/s10840-021-01041-8

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