Pooled-Analysis of Association of Sievers Bicuspid Aortic Valve Morphology With New Permanent Pacemaker and Conduction Abnormalities After Transcatheter Aortic Valve Replacement

Abstract

BackgroundStudies on the association of Sievers bicuspid aortic valve (BAV) morphology with conduction disorders after transcatheter aortic valve replacement (TAVR) have not reached consensus.MethodsWe here performed a pooled-analysis to explore whether Sievers type 1 BAV morphology increased the risk of post-TAVR conduction abnormalities and permanent pacemaker implantation (PPI) compared to type 0. Systematic literature searches through EMBASE, Medline, and Cochrane databases were concluded on 1 December 2021. The primary endpoint was post-TAVR new PPI and pooled as risk ratios (RRs) and 95% confidence intervals (CIs). Conduction abnormalities as the secondary endpoint were the composites of post-TAVR PPI and/or new-onset high-degree of atrial-ventricle node block and left-bundle branch block. Studies that reported incidence of outcomes of interest in both type 1 and type 0 BAV morphology who underwent TAVR for aortic stenosis were included.ResultsFinally, nine studies were included. Baseline characteristics were generally comparable, but type 1 population was older with a higher surgical risk score compared to type 0 BAV morphology. In the pooled-analysis type 1 BAV had significantly higher risk of post-TAVR new-onset conduction abnormalities (RR = 1.68, 95%CI 1.09–2.60, p = 0.0195) and new PPI (RR = 1.97, 95%CI 1.29–2.99, p = 0.0016) compared to type 0. Random-effects univariate meta-regression indicated that no significant association between baseline characteristics and PPI.ConclusionSievers type 1 BAV morphology was associated with increased risk of post-TAVR PPI and conduction abnormalities compared to type 0. Dedicated cohort is warranted to further validate our hypothesis.

Post‐TAVR conduction abnormalities leading to permanent pacemaker implantation: Risk factors, prevention, and management

“…5,7 The same correlation exists for the LV end-diastolic volume or diameter. 6,16,24 Lastly, Zhang et al 25 concluded that patients with Sievers type 1 bicuspid aortic valve (BAV) morphology (presence of a raphe or fusion between the two leaflets) are more predisposed to PPI after TAVR, compared with patients with Sievers type 0 BAV morphology (absence of a raphe or fusion between the two leaflets).…”