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Impact of Cusp-Overlap View for TAVR with Self-Expandable Valves on 30-Day Conduction Disturbances
Oscar A Mendiz1, Marko Noč2, Carlos M Fava1
1Cardiology and Cardiovascular Surgery Institute (ICyCC), Favaloro Foundation University Hospital, Buenos Aires, Argentina.
Journal of Interventional Cardiology
|May 19, 2021
Summary
The coaxial left ventricular outflow tract (COVL) view significantly reduced new left bundle branch block (LBBB) and pacemaker implantation (PPMI) after transcatheter aortic valve replacement (TAVR) compared to the conventional (CON) view.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
Background:
- Transcatheter aortic valve replacement (TAVR) is a key treatment for aortic stenosis.
- New-onset left bundle branch block (LBBB) and the need for permanent pacemaker implantation (PPMI) are common complications after TAVR.
- Optimizing implantation techniques may reduce these adverse events.
Purpose of the Study:
- To compare the incidence of LBBB and PPMI following TAVR using self-expandable valves with either the coaxial left ventricular outflow tract (COVL) view or the conventional (CON) view.
Main Methods:
- Retrospective analysis of 257 consecutive TAVR patients with self-expandable valves.
- Patients were grouped based on implantation view: COVL (n=156) or CON (n=101).
- Comparison of 30-day outcomes including LBBB, PPMI, death, stroke, and need for surgical valve replacement.
Main Results:
- The COVL group showed a significantly lower incidence of new-onset LBBB (5.8% vs. 12.9%, p=0.05) and PPMI (6.4% vs. 17.8%, p=0.004) compared to the CON group.
- No significant differences were observed in 30-day mortality, stroke, or need for surgical aortic valve replacement between the groups.
- Baseline characteristics were similar between the COVL and CON groups.
Conclusions:
- The COVL implantation view significantly reduces LBBB and PPMI rates after TAVR with self-expandable valves.
- This technique does not compromise other important TAVR outcomes.
- COVL represents a potentially improved implantation strategy for TAVR.
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