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

J Am Soc Echocardiogr. 2019 Nov;32(11):1416-1425. doi: 10.1016/j.echo.2019.06.012. Epub 2019 Aug 26.

Abstract

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: Echocardiography; Pacemaker; Transcatheter aortic valve replacement.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged, 80 and over
  • Aortic Valve / diagnostic imaging*
  • Aortic Valve / surgery
  • Aortic Valve Stenosis / complications
  • Aortic Valve Stenosis / diagnosis
  • Aortic Valve Stenosis / surgery*
  • Cardiomyopathy, Hypertrophic / complications
  • Cardiomyopathy, Hypertrophic / diagnosis*
  • Cardiomyopathy, Hypertrophic / physiopathology
  • Echocardiography
  • Female
  • Follow-Up Studies
  • Heart Septum / diagnostic imaging*
  • Heart Valve Prosthesis*
  • Humans
  • Male
  • Retrospective Studies
  • Risk Factors
  • Transcatheter Aortic Valve Replacement / methods*
  • Treatment Outcome