Cusp-overlap technique during TAVI using the self-expanding Portico FlexNav system.

Area of Science:

• Cardiovascular Medicine
• Interventional Cardiology
• Medical Devices

Background:

• Transcatheter aortic valve implantation (TAVI) is a common procedure for aortic stenosis.
• Conduction disturbances (CD) are a known complication after TAVI, particularly with self-expanding supra-annular devices.
• Limited data exist on the efficacy of the cusp overlap technique (COT) with intra-annular valves like the Portico system.

Purpose of the Study:

• To evaluate the feasibility and effectiveness of the cusp overlap technique (COT) during Portico transcatheter aortic valve implantation (TAVI).
• To determine if COT improves valve implantation depth and reduces new-onset conduction disturbances (CD).

Main Methods:

• A retrospective and prospective study involving 85 patients undergoing TAVI with the Portico FlexNav system.
• Patients were divided into two groups: standard 3-cusp view (n=43) and cusp overlap technique (COT) (n=42).
• Primary endpoints included implantation depth and new-onset CD (new-onset left bundle branch block and permanent pacemaker implantation).

Main Results:

• The COT group demonstrated significantly higher implantation depth (noncoronary cusp: 7.4±3.0 vs 4.9±3.9; P=.005).
• New-onset CD rates were significantly lower in the COT group (31.0% vs 58.1%; P=.012).
• Lower rates of permanent pacemaker implantation were observed with COT, especially in patients without pre-existing right bundle branch block (7.7% vs 31.0%; P=.011).

Conclusions:

• The cusp overlap technique (COT) is feasible for Portico transcatheter aortic valve implantation (TAVI).
• COT facilitates a higher valve implantation depth, which is associated with reduced rates of new-onset conduction disturbances.
• COT may be a valuable strategy to improve TAVI outcomes with intra-annular valves.