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<p>Transcatheter aortic valve replacement (TAVR) is an established therapy for severe aortic stenosis, although conduction disturbances, especially atrioventricular block and new-onset left bundle branch block (LBBB) remain associated with adverse outcomes. Short membranous septal length (MSL) has been linked to post-TAVR conduction abnormalities, but its prognostic significance is unclear. We retrospectively analyzed 258 patients who underwent transfemoral TAVR. MSL was measured on contrast-enhanced CT, and left ventricular ejection fraction (LVEF) was assessed at baseline, 1&#xa0;week, and 1&#xa0;year. The primary endpoint was all-cause mortality; secondary was a composite of mortality or heart failure hospitalization. Patients were classified by MSL ≤ 6&#xa0;mm or &gt; 6&#xa0;mm. The short MSL group had higher rates of new-onset LBBB (<i>p</i> = 0.047), mortality (<i>p</i> = 0.046), and the composite endpoint (<i>p</i> = 0.039). MSL ≤ 6&#xa0;mm independently predicted mortality (HR 3.66, 95% CI 1.52–16.2, <i>p</i> = 0.0012) and the composite outcome (HR 2.56, 95% CI 1.32–6.69, <i>p</i> = 0.0025). LVEF recovery at 1&#xa0;year was significantly impaired (<i>p</i> = 0.035), and these findings persisted after excluding patients with LBBB or pacemaker implantation. Incorporating MSL ≤ 6&#xa0;mm into a model with established risk factors improved discrimination for mortality (AUC 0.72 vs 0.67, <i>p</i> = 0.042; cfNRI 0.33). Short MSL was associated with impaired LVEF recovery and adverse outcomes after TAVR. MSL may serve as a simple CT-based marker for preprocedural risk stratification.</p>

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Impact of short membranous septal length on overall survival after transcatheter aortic valve replacement

  • 期刊论文

  • 发表日期：

    2026年2月24日

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  • Hiroyuki Tsurumi,
  • Yuichiro Toma,
  • Haruno Nagata,
  • Ayane Miyagi,
  • Shinya Shiohira,
  • Hidekazu Ikemiyagi,
  • Takaaki Nagano,
  • Takeshi Sasaki,
  • Masashi Iwabuchi,
  • Kojiro Furukawa,
  • Kenya Kusunose

摘要

Transcatheter aortic valve replacement (TAVR) is an established therapy for severe aortic stenosis, although conduction disturbances, especially atrioventricular block and new-onset left bundle branch block (LBBB) remain associated with adverse outcomes. Short membranous septal length (MSL) has been linked to post-TAVR conduction abnormalities, but its prognostic significance is unclear. We retrospectively analyzed 258 patients who underwent transfemoral TAVR. MSL was measured on contrast-enhanced CT, and left ventricular ejection fraction (LVEF) was assessed at baseline, 1 week, and 1 year. The primary endpoint was all-cause mortality; secondary was a composite of mortality or heart failure hospitalization. Patients were classified by MSL ≤ 6 mm or > 6 mm. The short MSL group had higher rates of new-onset LBBB (p = 0.047), mortality (p = 0.046), and the composite endpoint (p = 0.039). MSL ≤ 6 mm independently predicted mortality (HR 3.66, 95% CI 1.52–16.2, p = 0.0012) and the composite outcome (HR 2.56, 95% CI 1.32–6.69, p = 0.0025). LVEF recovery at 1 year was significantly impaired (p = 0.035), and these findings persisted after excluding patients with LBBB or pacemaker implantation. Incorporating MSL ≤ 6 mm into a model with established risk factors improved discrimination for mortality (AUC 0.72 vs 0.67, p = 0.042; cfNRI 0.33). Short MSL was associated with impaired LVEF recovery and adverse outcomes after TAVR. MSL may serve as a simple CT-based marker for preprocedural risk stratification.