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Transcatheter Aortic Valve Replacement with the Self-Expandable Core Valve Evolut Prosthesis Using the Cusp-Overlap

Philipp Maximilian Doldi1,2, Lukas Stolz1, Felix Escher3

  • 1Medizinische Klinik und Poliklinik I, Klinikum der Universität München, 81377 Munich, Germany.

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|March 25, 2022
PubMed
Summary

The cusp-overlap view (COP) implantation technique for transcatheter aortic valve replacement (TAVR) with the Evolut valve did not change technical success rates but significantly reduced the need for permanent pacemaker implantation (PPI). This suggests COP may improve TAVR outcomes.

Keywords:
TAVITAVRaortic stenosisconduction disturbancecusp-overlap viewpermanent pacemaker implantationself-expandable valvesthree-cusp view

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Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Medical Technology

Background:

  • Conduction disturbances and the need for permanent pacemaker implantation (PPI) remain significant challenges after transcatheter aortic valve replacement (TAVR) using self-expandable valves like the CoreValve Evolut.
  • The cusp-overlap view (COP) has emerged as a potentially superior imaging technique for TAVR, offering enhanced visualization during valve deployment compared to the traditional three-cusp view (TCV).

Purpose of the Study:

  • To systematically compare procedural outcomes, focusing on technical success and PPI rates, between TAVR with the CoreValve Evolut prosthesis using the COP versus the TCV implantation technique.
  • To evaluate the impact of the COP technique on reducing the incidence of permanent pacemaker implantation in patients undergoing TAVR.

Main Methods:

  • A retrospective analysis of 122 consecutive patients undergoing TAVR with the CoreValve Evolut prosthesis at a high-volume center.
  • Patients were divided into two groups: TCV implantation (n=61) and COP implantation (n=61).
  • Technical success was assessed according to the 2021 Valve Academic Research Consortium 3 (VARC-3) criteria, and the rate of permanent pacemaker implantation (PPI) was compared between the two groups.

Main Results:

  • There was no statistically significant difference in technical success rates between the TCV and COP groups (93.4% vs. 90.2%, p=0.51).
  • The rate of permanent pacemaker implantation (PPI) was significantly lower in the COP group compared to the TCV group (13.1% vs. 27.9%, p=0.047).
  • The odds ratio for PPI was 0.39 (95% CI 0.15, 0.97) favoring the COP technique.

Conclusions:

  • The cusp-overlap view (COP) implantation technique for CoreValve Evolut transcatheter aortic valve replacement does not compromise technical success.
  • Utilizing the COP technique is associated with a significantly reduced risk of permanent pacemaker implantation following TAVR.
  • The COP view may be a valuable tool for optimizing CoreValve Evolut prosthesis implantation and potentially mitigating conduction disturbances.