Clin Res Cardiol (2022). https://doi.org/10.1007/s00392-022-02002-5

Transcatheter aortic valve implantation in patients with significant septal hypertrophy
M. Beyer1, T. J. Demal1, O. Bhadra1, M. Linder2, S. Ludwig3, D. Grundmann3, L. Voigtländer4, L. Waldschmidt4, J. Schirmer1, N. Schofer4, S. Pecha1, M. Seiffert2, S. Blankenberg5, H. Reichenspurner1, L. Conradi1, D. Westermann4, A. Schäfer1
1Klinik und Poliklinik für Herz- und Gefäßchirurgie, Universitäres Herz- und Gefäßzentrum Hamburg GmbH, Hamburg; 2Klinik und Poliklinik für Kardiologie, Universitäres Herz- und Gefäßzentrum Hamburg GmbH, Hamburg; 3Klinik für Kardiologie, Universitäres Herz- und Gefäßzentrum Hamburg GmbH, Hamburg; 4Allgemeine und Interventionelle Kardiologie, Universitäres Herz- und Gefäßzentrum Hamburg GmbH, Hamburg; 5Klinik für Kardiologie, Universitäres Herz- und Gefäßzentrum UKE Hamburg GmbH, Hamburg;

Objectives

Transcatheter aortic valve implantation (TAVI) is a safe treatment for patients with symptomatic severe aortic stenosis (AS) with proven efficacy in patients across all risk strata. Severe AS is frequently accompanied by left ventricular hypertrophy due to chronic pressure overload. Previous reports have shown that septal hypertrophy may adversely affect outcomes after TAVI. This analysis examined influence of septal hypertrophy on acute outcomes after TAVI.

Methods

Between 12/2009 and 11/2020, 812 patients (53.8% male, 80.6±6.8 years, log EuroSCORE II 7.7±7.2) with documented interventricular septum depth (IVSD) underwent TAVI and were included for analysis. Baseline, periprocedural and outcome parameters of patients with high (≥ 14 mm, study group) and low IVSD (< 14 mm, control group) were compared. As cut-off between cohorts the 75th percentile of a corresponding IVSD histogram was used. Data were retrospectively analyzed according to updated Valve Academic Research Consortium (VARC-2) definitions. Comparison of outcome parameters was adjusted for baseline differences between groups using logistic and linear regression analysis.

Results

Of 812 included patients, 326 and 486 patients were assigned to study and control groups respectively. Patients in the control group less frequently reached the VARC-2 adjudicated composite endpoint device success (92% vs. 95.9%; OR=2.345; 95% CI: 1.06-5.2; p=0.036). Postprocedural mean transvalvular gradients were significantly higher in study compared to control group (8.9±4.7 vs. 7.6±3.8 mmHg, p=0.002). Rate of ≥ moderate paravalvular leakage was not different between groups (2.5% (n=8) vs. 2.9% (n=14), p=0.974).

There was no significant difference between groups regarding rate of postprocedural permanent pacemaker implantation (12.9% (n=42) vs. 13.8% (n=67), p=0.458), and 30-day-mortality (6.4% (n=21) vs. 6.0% (n=29), p=0.329).  

Conclusion

In this analysis, TAVI in patients with significant hypertrophy of the interventricular septum was associated with lower device success rates, mostly due to increased postprocedural transvalvular pressure gradients. Possible explanations for this finding may be incomplete expansion of stent inflow or remaining increased flow acceleration at the height of the left ventricular outflow tract.

These results suggest septal hypertrophy may negatively affect hemodynamic outcomes after TAVI and should be considered in preprocedural planning.


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