Transcatheter Aortic Valve Implantation in Patients with Significant Septal Hypertrophy

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

Methods: Between 2009 and 2021, 1.033 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 1.033 patients, 585 and 448 patients were allocated to group 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 rates of VARC-3 adjudicated composite endpoints 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, groups showed no significant differences regarding 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.

Publication History

Article published online:
13 February 2024