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Related Concept Videos

Mitral Regurgitation III: Medical Management01:25

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Mitral regurgitation (MR) is characterized by retrograde blood circulation from the left ventricle into the left atrium due to inadequate mitral valve closure. The severity of the condition, symptoms, and underlying cause determine treatment strategies.Monitoring and Pharmacological TreatmentPatients with mild to moderate MR typically do not need immediate intervention but regular monitoring to assess progression and guide treatment. Patients with mild MR should have an echocardiogram every 3-5...
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Mitral Stenosis III: Medical Management01:26

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Mitral stenosis, a condition marked by the narrowing of the mitral valve, necessitates an integrated approach for effective management. This approach includes preventative measures, medical therapy, and surgical interventions to reduce symptoms and prevent complications.PreventionPrevention of mitral stenosis primarily focuses on reducing the incidence of bacterial infections, particularly streptococcal infections, which can lead to rheumatic fever and subsequent valvular damage. Timely...
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The Cusp Overlap Technique Reduces Pacemaker Implantation in TAVR: A Systematic Review and Meta-analysis.

Mohammad Hazique1, Zubair Jafar2, Sameer Lohana1

  • 1Department of Internal Medicine, Nuvance Health/Vassar Brothers Medical Center, Poughkeepsie, New York.

The American Journal of Cardiology
|June 29, 2025
PubMed
Summary

The cusp overlap view (COV) technique for transcatheter aortic valve replacement (TAVR) significantly reduces the need for permanent pacemaker implantation (PPI) in patients receiving self-expanding valves (SEVs). This advanced imaging approach also shortens hospital stays and improves procedural outcomes.

Keywords:
TAVRconduction disturbancecusp overlap projectionpacemakertranscatheter aortic valve replacement

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Area of Science:

  • Cardiovascular Medicine
  • Interventional Cardiology
  • Medical Imaging

Background:

  • Transcatheter aortic valve replacement (TAVR) is a primary treatment for symptomatic aortic stenosis.
  • Conduction disturbances requiring permanent pacemaker implantation (PPI) are a significant complication, especially with self-expanding valves (SEVs).
  • The cusp overlap view (COV) imaging technique aims for improved valve deployment compared to the conventional coplanar view (CPV).

Purpose of the Study:

  • To systematically review and meta-analyze the impact of the COV technique versus the CPV on TAVR outcomes.
  • To assess the effect of COV on permanent pacemaker implantation (PPI) rates and other procedural metrics.

Main Methods:

  • A systematic review and meta-analysis of 14 studies involving 5,266 TAVR patients.
  • Pooled data using the DerSimonian-Laird random-effects model with I² for heterogeneity analysis.
  • Comparison of outcomes between the COV and CPV techniques.

Main Results:

  • The COV technique was associated with significantly lower PPI rates (11.2% vs 17.7%; OR = 0.63; p <0.0001).
  • Patients in the COV group had shorter hospital stays (SMD = -0.56; p = 0.016) and a lower mean transvalvular gradient (SMD = -0.10; p = 0.049).
  • COV indicated a higher valve position, with a significantly lower mean distance from non-coronary and left coronary cusps (SMD = -0.21; p <0.001).

Conclusions:

  • The cusp overlap view (COV) technique significantly reduces PPI rates and improves procedural outcomes in TAVR with SEVs.
  • COV enhances patient outcomes by minimizing conduction disturbances and hospital stays, optimizing resource utilization.
  • Further randomized controlled trials are recommended to confirm benefits and standardize TAVR protocols.