{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,6,26]],"date-time":"2025-06-26T12:10:44Z","timestamp":1750939844215,"version":"3.40.5"},"reference-count":19,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2025,2,25]],"date-time":"2025-02-25T00:00:00Z","timestamp":1740441600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Cathet Cardio Intervent"],"published-print":{"date-parts":[[2025,5]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Angulation of virtual basal ring (VBR), also known as aortic annulus, in relation to sino\u2010tubular junction (STJ) may lead to greater exposure of implanted stent to the conduction system, consequently increasing the risk of left bundle branch block (LBBB).<\/jats:p><\/jats:sec><jats:sec><jats:title>Aims<\/jats:title><jats:p>We sough to measure the VBR\u2010STJ angle and explore its impact on the development of LBBB post\u2010TAVR.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Patients undergoing TAVR using the Sapiens 3 valve between 2016 and 2021, without pre\u2010TAVR conduction anomalies were included. The angle between the VBR and the ascending aorta was measured as the angle between the VBR plane and the plane of the STJ on cardiac CT, along with the annulus dimensions. TAVR implantation depth was measured on fluoroscopy images.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A total of 1204 patients were included, with 145 having new\u2010onset LBBB. The VBR\u2010STJ angle was significantly greater in the new\u2010onset LBBB group (7.3\u2009\u00b1\u20094.7 vs. 5.9\u2009\u00b1\u20094.6, <jats:italic>p<\/jats:italic>\u2009=\u20090.002), and the difference in implantation depth between the levels of right and none coronary cusp (RCC and NCC) was significantly correlated with the VBR\u2010STJ angle (<jats:italic>r<\/jats:italic>\u2009=\u20090.3, <jats:italic>p<\/jats:italic>\u2009=\u20090.03). This angle was further associated with new\u2010onset LBBB after adjustment to patient and procedural characteristics (OR 1.08 CI: [1.04, 1.13], <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Patients developing LBBB have larger VBR\u2010STJ angle which was associated with greater depth of implantation of the TAVR valve below the RCC compared to the NCC. Precise understanding of the aortic root anatomy can help to predict onset of LBBB which in turn can inform decision\u2010making regarding optimal way of treating aortic stenosis and may improve procedure planning.<\/jats:p><\/jats:sec>","DOI":"10.1002\/ccd.31434","type":"journal-article","created":{"date-parts":[[2025,3,11]],"date-time":"2025-03-11T13:12:38Z","timestamp":1741698758000},"page":"1375-1380","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Aortic Root Anatomy and Impact on New\u2010Onset Left Bundle Branch Block\u00a0After Transcatheter Aortic Valve Implantation"],"prefix":"10.1002","volume":"105","author":[{"given":"Habib","family":"Layoun","sequence":"first","affiliation":[{"name":"Internal Medicine Department Cleveland Clinic Cleveland Ohio USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Joseph","family":"Kassab","sequence":"additional","affiliation":[{"name":"Heart Vascular and Thoracic Institute, Cleveland Clinic Cleveland Ohio USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michel Chedid El","family":"Helou","sequence":"additional","affiliation":[{"name":"Heart Vascular and Thoracic Institute, Cleveland Clinic Cleveland Ohio USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Joseph El","family":"Dahdah","sequence":"additional","affiliation":[{"name":"Heart Vascular and Thoracic Institute, Cleveland Clinic Cleveland Ohio USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Odette","family":"Iskandar","sequence":"additional","affiliation":[{"name":"Heart Vascular and Thoracic Institute, Cleveland Clinic Cleveland Ohio USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maryam Muhammad Ali Majeed","family":"Saidan","sequence":"additional","affiliation":[{"name":"Heart Vascular and Thoracic Institute, Cleveland Clinic Cleveland Ohio USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1399-6487","authenticated-orcid":false,"given":"Abdelrahman","family":"Abushouk","sequence":"additional","affiliation":[{"name":"Heart Vascular and Thoracic Institute, Cleveland Clinic Cleveland Ohio USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Toshiaki","family":"Isogai","sequence":"additional","affiliation":[{"name":"Heart Vascular and Thoracic Institute, Cleveland Clinic Cleveland Ohio USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Grant","family":"Reed","sequence":"additional","affiliation":[{"name":"Heart Vascular and Thoracic Institute, Cleveland Clinic Cleveland Ohio USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rishi","family":"Puri","sequence":"additional","affiliation":[{"name":"Heart Vascular and Thoracic Institute, Cleveland Clinic Cleveland Ohio USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Oussama M.","family":"Wazni","sequence":"additional","affiliation":[{"name":"Heart Vascular and Thoracic Institute, Cleveland Clinic Cleveland Ohio USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6048-7955","authenticated-orcid":false,"given":"Amar","family":"Krishnaswamy","sequence":"additional","affiliation":[{"name":"Heart Vascular and Thoracic Institute, Cleveland Clinic Cleveland Ohio USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Serge","family":"Harb","sequence":"additional","affiliation":[{"name":"Heart Vascular and Thoracic Institute, Cleveland Clinic Cleveland Ohio USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0026-3391","authenticated-orcid":false,"given":"Samir","family":"Kapadia","sequence":"additional","affiliation":[{"name":"Heart Vascular and Thoracic Institute, Cleveland Clinic Cleveland Ohio USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2025,2,25]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2021.09.855"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.117.028352"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehz924"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1002\/ca.24032"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCINTERVENTIONS.108.780858"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2008.12.013"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2018.10.044"},{"key":"e_1_2_8_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcct.2017.01.007"},{"key":"e_1_2_8_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cpcardiol.2010.01.002"},{"key":"e_1_2_8_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcin.2020.09.063"},{"key":"e_1_2_8_12_1","doi-asserted-by":"publisher","DOI":"10.3389\/fcvm.2024.1370244"},{"key":"e_1_2_8_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2014.11.027"},{"key":"e_1_2_8_14_1","doi-asserted-by":"publisher","DOI":"10.1002\/ccd.30488"},{"key":"e_1_2_8_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.hrthm.2022.08.001"},{"key":"e_1_2_8_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcin.2019.03.025"},{"key":"e_1_2_8_17_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcin.2012.12.128"},{"key":"e_1_2_8_18_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcin.2019.05.056"},{"key":"e_1_2_8_19_1","doi-asserted-by":"publisher","DOI":"10.1002\/ccd.26503"},{"key":"e_1_2_8_20_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCINTERVENTIONS.115.003635"}],"container-title":["Catheterization and Cardiovascular Interventions"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/ccd.31434","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,5,7]],"date-time":"2025-05-07T11:24:38Z","timestamp":1746617078000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/ccd.31434"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,2,25]]},"references-count":19,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2025,5]]}},"alternative-id":["10.1002\/ccd.31434"],"URL":"https:\/\/doi.org\/10.1002\/ccd.31434","archive":["Portico"],"relation":{},"ISSN":["1522-1946","1522-726X"],"issn-type":[{"type":"print","value":"1522-1946"},{"type":"electronic","value":"1522-726X"}],"subject":[],"published":{"date-parts":[[2025,2,25]]},"assertion":[{"value":"2024-10-05","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-01-21","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-02-25","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}