Evidence map›Paper›PMID 40007245›Full record

ArticleCatheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions2025

Aortic Root Anatomy and Impact on New-Onset Left Bundle Branch Block After Transcatheter Aortic Valve Implantation.

Habib Layoun, Joseph Kassab, Michel Chedid El Helou, Joseph El Dahdah, Odette Iskandar, Maryam Muhammad Ali Majeed Saidan, Abdelrahman Abushouk, Toshiaki Isogai, Grant Reed, Rishi Puri and 4 more

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Article in Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

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4 · The record

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5 · Who and what money

Authors and funding

14 authors.

Habib LayounInternal Medicine Department, Cleveland Clinic, Cleveland, Ohio, USA.
Joseph KassabHeart Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA.
Michel Chedid El HelouHeart Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA.
Joseph El DahdahHeart Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA.
Odette IskandarHeart Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA.
Maryam Muhammad Ali Majeed SaidanHeart Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA.
Abdelrahman AbushoukHeart Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA.ORCID 0000-0003-1399-6487
Toshiaki IsogaiHeart Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA.
Grant ReedHeart Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA.
Rishi PuriHeart Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA.
Oussama M WazniHeart Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA.
Amar KrishnaswamyHeart Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA.ORCID 0000-0001-6048-7955
Serge HarbHeart Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA.
Samir KapadiaHeart Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA.ORCID 0000-0002-0026-3391

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundAngulation of virtual basal ring (VBR), also known as aortic annulus, in relation to sino-tubular junction (STJ) may lead to greater exposure of implanted stent to the conduction system, consequently increasing the risk of left bundle branch block (LBBB).

aimsWe sough to measure the VBR-STJ angle and explore its impact on the development of LBBB post-TAVR.

methodsPatients undergoing TAVR using the Sapiens 3 valve between 2016 and 2021, without pre-TAVR conduction anomalies were included. The angle between the VBR and the ascending aorta was measured as the angle between the VBR plane and the plane of the STJ on cardiac CT, along with the annulus dimensions. TAVR implantation depth was measured on fluoroscopy images.

resultsA total of 1204 patients were included, with 145 having new-onset LBBB. The VBR-STJ angle was significantly greater in the new-onset LBBB group (7.3 ± 4.7 vs. 5.9 ± 4.6, p = 0.002), and the difference in implantation depth between the levels of right and none coronary cusp (RCC and NCC) was significantly correlated with the VBR-STJ angle (r = 0.3, p = 0.03). This angle was further associated with new-onset LBBB after adjustment to patient and procedural characteristics (OR 1.08 CI: [1.04, 1.13], p < 0.001).

conclusionPatients developing LBBB have larger VBR-STJ angle which was associated with greater depth of implantation of the TAVR valve below the RCC compared to the NCC. Precise understanding of the aortic root anatomy can help to predict onset of LBBB which in turn can inform decision-making regarding optimal way of treating aortic stenosis and may improve procedure planning.

Indexed as

Aortic ValveAortic Valve StenosisBundle-Branch BlockTranscatheter Aortic Valve ReplacementAgedAged, 80 and overAortographyFemaleHeart Valve ProsthesisHumansMaleProsthesis DesignRetrospective StudiesRisk AssessmentRisk FactorsTime Factorsaortic rootleft bundle branch blocktranscatheter aortic valve replacement

Identifiers

PMID40007245
PMCPMC12057298

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