Impact of Cusp-Overlap View for TAVR with Self-Expandable Valves on 30-Day Conduction Disturbances

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.