Clinical Investigation Echocardiography in Percutaneous Valve Interventions| Volume 32, ISSUE 11, P1416-1425, November 01, 2019

The Impact of Basal Septal Hypertrophy on Outcomes after Transcatheter Aortic Valve Replacement

Published:August 26, 2019DOI:https://doi.org/10.1016/j.echo.2019.06.012

      Highlights

      • Basal septal hypertrophy (BSH) is present in 18.6% of patients receiving TAVR.
      • BSH has been postulated to associate with complications after TAVR.
      • In this study, patients with BSH received post-dilation more frequently.
      • In this study, BSH was not associated with adverse outcomes at 30 days post TAVR.

      Background

      The role of basal septal hypertrophy (BSH) on preprocedural transthoracic echocardiography in transcatheter aortic valve replacement (TAVR) is unknown.

      Methods

      Medical charts and preprocedural transthoracic echocardiograms of 378 patients who underwent TAVR were examined. The association between BSH and the primary composite outcome of valve pop-out, recapture, embolization, aborted procedure, conversion to open procedure, new conduction disturbance, or need for permanent pacemaker ≤30 days after TAVR was evaluated. Patients with preexisting pacemakers were excluded. Sensitivity analyses were performed varying the definition of BSH.

      Results

      Of 296 TAVR patients (78.3%) with interpretable images, 55 (18.6%) had BSH at a median of 40 days (interquartile range, 19–62 days) before TAVR. Age and sex were similar among those with and without BSH. BSH patients received postdilation more frequently (BSH+ vs BSH−: 41.8% vs 29.9%, P = .04). A total of 50 individuals (16.9%) received pacemakers within 30 days, and 128 (43.2%) developed conduction disturbances (with left bundle branch block most common), without differences between groups. BSH was unrelated to the primary outcome on multivariate analysis (adjusted odds ratio BSH+ vs BSH−, 0.94; 95% CI, 0.42−2.11; P = .88).

      Conclusions

      In this convenience sample of TAVR recipients at a large academic medical center, patients with BSH were more likely to receive postdilation. BSH was not associated with procedural or conduction outcomes after TAVR in patients without preexisting pacemakers.

      Keywords

      Abbreviations:

      BIDMC (Beth Israel Deaconess Medical Center), BSH (Basal septal hypertrophy), ESV (Edwards SAPIEN valve), MCV (Medtronic CoreValve), PPM (Permanent pacemaker), TAVR (Transcatheter aortic valve replacement), TTE (Transthoracic echocardiography), TVT (Transcatheter Valve Therapy)
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