ISSN 2149-2263 | E-ISSN 2149-2271
The Anatolian Journal of Cardiology
Structural Changesofthe Right Fibrous Trigone as a Risk Factor for Conduction Disturbance After Transcatheter Aortic Valve Implantation [Anatol J Cardiol]
Anatol J Cardiol. 2022; 26(7): 532-542 | DOI: 10.5152/AnatolJCardiol.2022.987

Structural Changesofthe Right Fibrous Trigone as a Risk Factor for Conduction Disturbance After Transcatheter Aortic Valve Implantation

Serkan Aslan1, Aysel Türkvatan2, Çağdaş Topel2, Ahmet Güner1, Ali Rıza Demir1, Serkan Kahraman1, Ömer Çelik1, Mehmet Ertürk1
1Department of Cardiology, University of Health Sciences, İstanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, İstanbul, Turkey
2Department of Radiology, University of Health Sciences, İstanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, İstanbul, Turkey

Background: The right fibrous trigone, which the His bundle penetrates, is part of the subaortic area adjacent to the membranous septum. Structural alterations of the right fibrous trigone may cause conduction disturbance as a result of compression in this area after transcatheter aortic valve implantation. This study analyzed the hypothesis of whether imaging parameters of the RFT could predict the risk of conduction disturbance after transcatheter aortic valve implantation.

Methods: We retrospectively examined 209 patients who underwent transfemoral transcatheter aortic valve implantationat a tertiary cardiac center. The different valve models were divided into 2 groups: self-expanding valve and balloon-expandable valve. Using pre-procedure computed tomography, we evaluated for the alterations of the right fibrous trigone.

Results: New conduction disturbance was seen in 75 of 209 (35.8%) patients. Receiver operating characteristics plots displayed a right fibrous trigone density of −6 Hounsfieldunit for SEV and −16 Hounsfield unit for balloon-expandable valve as the optimal cut- off points for prediction conduction disturbance. In multiple regression analyses, the high density of RFT emerged as an independent predictor of conduction disturbance in both the self-expanding valve (odds ratio: 1.01, 95% CI: 1.01 to 1.02, P = 0.035) and bal- loon-expandable valve (odds ratio: 1.01, 95% CI: 1.01 to 1.03, P = 0.017) groups. A shorter membranous septum length and a greater implantation depth were also found to be significantly associated with a higher incidence of conduction disturbance in both trans- catheter aortic valve implantation groups.

Conclusion: High density of right fibrous trigone is independently associated with con- duction disturbance after transcatheter aortic valve implantation, and its pre-proce- dure computed tomography evaluation can help predict the new-onset of conduction disturbance.

Keywords: Atrioventricular block, conduction disturbance, left bundle branch block, right fibrous trigone, transcatheter aortic valve implantation

Serkan Aslan, Aysel Türkvatan, Çağdaş Topel, Ahmet Güner, Ali Rıza Demir, Serkan Kahraman, Ömer Çelik, Mehmet Ertürk. Structural Changesofthe Right Fibrous Trigone as a Risk Factor for Conduction Disturbance After Transcatheter Aortic Valve Implantation. Anatol J Cardiol. 2022; 26(7): 532-542

Corresponding Author: Serkan Aslan
Manuscript Language: English


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