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.

中文翻译：

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膜间隔的解剖特征可预测接受经导管主动脉瓣置换术的患者对起搏器的需求

目的

我们旨在研究 TAVR 后需要 PPM 的患者膜间隔 (MS) 的特征及其与主动脉瓣 (AoV) 和主动脉瓣环 (AA) 的关系。

方法

我们对 2016 年至 2018 年接受 TAVR 的 144 名患者进行了一项回顾性病例对照研究。将 34 名需要 PPM 植入的患者与 34 名不需要起搏的匹配对照进行了比较。MS 总长度、超环形 MS (SA-MS) 长度、环形下 MS (IA-MS) 长度、AA 和 MS (AA-MS) 平面之间的角度以及 AoV 钙化程度 (AVC)从术前CT获得。AoV 假体植入深度通过术中透视获得。

结果

瓣膜类型（自扩张：23 例对 25 例对照，球囊扩张：11 对 9， p  = 0.79）、AVC 程度（0.65 cm ³对 0.82 cm ³，p  = 0.62）没有显着差异，或植入深度（7.76 mm vs 7.28 mm，p  = 0.83）。与对照组相比，MS 总长度没有差异（6.68 毫米对 6.06 毫米，p  = 0.97），但 IA-MS 明显更短（3.64 毫米对 4.56 毫米，p  = 0.02），SA-MS 显着缩短需要 PPM 的患者更长（2.73 毫米对 1.67 毫米，p  = 0.02）。需要 PPM 的患者也有更大的 AA-MS 角度（103.5° vs 96.7°，p  = 0.01）。

结论

MS 相对于 AA 的位置和环形平面下方的 MS 距离与需要 PPM 的 TAVR 后传导异常更密切相关，而不是 MS 的绝对长度。接受具有这种解剖结构的 TAVR 的患者需要 PPM 的风险更高，应监测这些并发症的发生。