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Cusp overlap method for self-expanding transcatheter aortic valve replacement.

Talal F Aljabbary1,2, Ikki Komatsu3, Tomoki Ochiai1,4

  • 1Schulich Heart Program, Sunnybrook Health Sciences Center, University of Toronto, Toronto, Canada.

Catheterization and Cardiovascular Interventions : Official Journal of the Society for Cardiac Angiography & Interventions
|November 27, 2023
PubMed
Summary
This summary is machine-generated.

The cusp-overlap technique significantly reduced the need for permanent pacemaker (PPM) implantation after transcatheter aortic valve replacement (TAVR) with self-expanding valves compared to the standard three-cusp technique. This approach may improve patient outcomes by lowering complication rates.

Keywords:
TAVRcusp overlapself-expanding

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Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Medical Devices

Background:

  • Transcatheter aortic valve replacement (TAVR) using self-expanding (SE) valves is associated with conduction disturbances requiring permanent pacemaker (PPM) implantation.
  • Minimizing PPM implantation is crucial for improving TAVR outcomes.

Purpose of the Study:

  • To compare the rates of new PPM implantation between the cusp-overlap technique and the conventional three-cusp coplanar implantation technique for TAVR with SE valves.
  • To evaluate in-hospital and 30-day outcomes related to PPM implantation and heart block.

Main Methods:

  • A retrospective study comparing 519 patients who underwent TAVR with SE Evolut R or PRO valves using the cusp-overlap technique (July 2018-September 2020) to 128 patients who underwent TAVR with the standard three-cusp technique (April 2016-March 2017).
  • Data on baseline characteristics, in-hospital, and 30-day outcomes, including new complete heart block and PPM implantation, were analyzed.

Main Results:

  • The cusp-overlap technique group showed significantly lower in-hospital rates of complete heart block (9.4% vs. 23.4%) and PPM implantation (8% vs. 21%) compared to the standard technique.
  • At 30 days, these significant reductions persisted, with lower rates of complete heart block (11% vs. 23%) and PPM implantation (10% vs. 21%) in the cusp-overlap group.
  • The incidence of new left bundle branch block (LBBB) was similar between the two techniques at both in-hospital and 30-day follow-up.

Conclusions:

  • The cusp-overlap approach for TAVR with SE Evolut valves is associated with significantly lower rates of permanent pacemaker implantation compared to the standard three-cusp technique.
  • This technique offers potential advantages in reducing conduction disturbances and the need for PPM implantation post-TAVR.