Impact of membranous septum length and valve calcification on permanent pacemaker implantation after surgical aortic valve replacement.
retrospective_cohort · Level III
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- Record sourced from PubMed, PMID 41932435.
- Also identified by DOI 10.1016/j.jtcvs.2026.03.599.
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Abstract
Conduction abnormalities requiring permanent pacemaker implantation after surgical aortic valve replacement are associated with worse postoperative outcomes. Although membranous septum length measured on preprocedural computed tomography is a known predictor for permanent pacemaker implantation after transcatheter aortic valve replacement, its impact in surgical aortic valve replacement is not fully understood. We evaluated 425 patients who underwent surgical aortic valve replacement and had preoperative computed tomography imaging. Patients with aortic root surgery, endocarditis, prior aortic valve intervention, or prior permanent pacemaker implantation were excluded. Membranous septum length was measured using the infra-annular method. The primary end point was permanent pacemaker implantation for symptomatic atrioventricular block during the same period of care. Factors associated with permanent pacemaker implantation were evaluated using logistic regression and Fadden's pseudo-R<sup>2</sup> analyses. Thirty-two patients (7.5%) received permanent pacemaker implantation. Median time to permanent pacemaker implantation was 5 (4-7) days. Preexisting complete right bundle branch block, higher aortic valve calcium score, and shorter membranous septum length were significantly associated with permanent pacemaker implantation (all P < .05). Membranous septum length demonstrated the greatest explanatory value (pseudo-R<sup>2</sup> = 0.08) compared with aortic valve calcium score (0.03) and complete right bundle branch block (0.04). A multivariable model incorporating membranous septum length and calcium score in addition to complete right bundle branch block provided the best overall fit and explained the largest proportion of variance. Short membranous septum length and high aortic valve calcium score on preoperative computed tomography were associated with increased risk of permanent pacemaker implantation after surgical aortic valve replacement. These findings support the expanding role of computed tomography-based anatomic assessment in surgical planning and underscore the need for prospective studies to refine risk stratification and guide operative strategies.