Transcatheter aortic valve implantation in patients with significant septal hypertrophy

Martin Beyer; Till Joscha Demal; Oliver D Bhadra; Matthias Linder; Sebastian Ludwig; David Grundmann; Lisa Voigtlaender-Buschmann; Lara Waldschmidt; Johannes Schirmer; Niklas Schofer; Simon Pecha; Stefan Blankenberg; Hermann Reichenspurner; Lenard Conradi; Moritz Seiffert; Andreas Schaefer

doi:10.1007/s00392-024-02432-3

Transcatheter aortic valve implantation in patients with significant septal hypertrophy

Clin Res Cardiol. 2024 Mar 11. doi: 10.1007/s00392-024-02432-3. Online ahead of print.

Authors

Martin Beyer^#¹, Till Joscha Demal^#², Oliver D Bhadra², Matthias Linder³, Sebastian Ludwig³, David Grundmann³, Lisa Voigtlaender-Buschmann³, Lara Waldschmidt³, Johannes Schirmer², Niklas Schofer³, Simon Pecha², Stefan Blankenberg³, Hermann Reichenspurner², Lenard Conradi², Moritz Seiffert³, Andreas Schaefer²

Affiliations

¹ Department of Cardiovascular Surgery, University Heart & Vascular Center Hamburg, Martinistraße 52, 20246, Hamburg, Germany. ma.beyer@uke.de.
² Department of Cardiovascular Surgery, University Heart & Vascular Center Hamburg, Martinistraße 52, 20246, Hamburg, Germany.
³ Department of Cardiology, University Heart & Vascular Center Hamburg, 20246, Hamburg, Germany.

^# Contributed equally.

PMID: 38466346
DOI: 10.1007/s00392-024-02432-3

Abstract

Background: Previous reports suggest septal hypertrophy with an interventricular septum depth (IVSD) ≥ 14 mm may adversely affect outcomes after transcatheter aortic valve implantation (TAVI) due to suboptimal valve placement, valve migration, or residual increased LVOT pressure gradients.

Aims: This analysis investigates the impact of interventricular septal hypertrophy on acute outcomes after TAVI.

Methods: Between 2009 and 2021, 1033 consecutive patients (55.8% male, 80.5 ± 6.7 years, EuroSCORE II 6.3 ± 6.5%) with documented IVSD underwent TAVI at our center and were included for analysis. Baseline, periprocedural, and 30-day outcome parameters of patients with normal IVSD (< 14 mm; group 1) and increased IVSD (≥ 14 mm; group 2) were compared. Data were retrospectively analyzed according to updated Valve Academic Research Consortium-3 (VARC-3) definitions. Comparison of outcome parameters was adjusted for baseline differences between groups using logistic and linear regression analyses.

Results: Of 1033 patients, 585 and 448 patients were allocated to groups 1 and 2, respectively. There was no significant difference between groups regarding transfemoral access rate (82.6% (n = 478) vs. 86.0% (n = 381), p = 0.157). Postprocedural mean transvalvular pressure gradient was significantly increased in group 2 (group 1, 7.8 ± 4.1 mmHg, vs. group 2, 8.9 ± 4.9 mmHg, p = 0.046). Despite this finding, there was no significant difference between groups regarding the rates of VARC-3 adjudicated composite endpoint device success (90.0% (n = 522) vs. 87.6% (n = 388), p = 0.538) or technical success (92.6% (n = 542) vs. 92.6% (n = 415), p = 0.639). Moreover, the groups showed no significant differences regarding the rates of paravalvular leakage ≥ moderate (3.1% (n = 14) vs. 2.6% (n = 9), p = 0.993), postprocedural permanent pacemaker implantation (13.4% (n = 77) vs. 13.8% (n = 61), p = 0.778), or 30-day mortality (5.1% (n = 30) vs. 4.5% (n = 20), p = 0.758).

Conclusion: Although transvalvular mean pressure gradients were significantly higher in patients with increased IVSD after TAVI, acute outcomes were comparable between groups suggesting no early impact of adverse hemodynamics due to elevated IVSD. However, how these differences in hemodynamic findings may affect mid- and long-term outcomes, especially in terms of valve durability, needs to be evaluated in further investigations.

Keywords: Aortic valve stenosis; Septal hypertrophy; TAVI; TAVR.