TAVR has been shown beneficial, especially in high risk or inoperable patients. However, there are limitations to its use, especially with self-expanding valves, which are the need for pacemaker implantation and ECG changes after procedure.
To address this matter, researchers assessed the right and left cusp overlap effect on 254 patients undergoing TAVR with self-expanding valves. 162 of these patients were treated with the traditional technique (TT), and 92 with the cusp overlap technique (COT).
The primary endpoints were ECG changes and a combined endpoint including pacemaker implantation, hospitalization, or cardiovascular death at 1 year. To match for differences in the populations, propensity score was used, resulting in 92 patients in each group.
Mean patient age was 83, half were men and most of them presented hypertension; 23% were diabetic, 16% had peripheral vascular disease and 12% MI.
Ejection fraction was conserved, mean gradient was 46 mmhg, and valve aortic area was 0.70 cm2.
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Offset ECG had shown 22% atrioventricular block (AVB), 12% left bundle branch block (LBBB), 12% right bundle branch block (RBBB), and 8% high grade atrioventricular block (HGAVB).
During the procedure, there were no significant differences in pre or post dilation, and mean valve diameter was 29 mm.
24 hours after procedure, COT group showed lower incidence of LBBB, and less P and QRS wave prolongation.
At one year, COT showed a significant reduction of LBBB (49% vs. 27% p=0.002), and less P wave (13.1±21.0 msec vs 5.47±12.5 msec; P=.003) and QRS prolongation (29.77±27.0 msec vs 16.38±25.4 msec, P <.001), with a significant reduction in the combined primary endpoint (SHR, 0.39 [CI95%, 0.21-0.76]; P=.005)
Even though there were no significant differences in mortality, cardiovascular and all-cause hospitalizations were higher in the TT group.
Although there were no significant differences, the need for pacemaker implantation was numerically lower in the COT group (15.2% vs 10.9%, p=0.376).
Conclusion
After one year, TAVR with COT showed lower incidence of LBBB and lower alteration of P and QRS waves vs. TT. COT was associated with a statistically significant reduction of the combined cardiovascular end point.
Dr. Carlos Fava.
Member of the Editorial Board of SOLACI.org.
Original Title: Self-expanding TAVI using the cusp overlap technique versus the traditional technique: electrocardiogram changes and 1-year cardiovascular outcomes.
Reference: Yva´n R. Persia-Paulino, et al. Rev Esp Cardiol. 2024;77(1):29–38.
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