In Europe and the US, aortic stenosis is the most frequent cause of valve intervention, both surgical and percutaneous, and, as we all know, TAVR has made great progress in this regard.
However, this technique has an Achilles heel when it comes to self-expandable valves: definite pacemaker implantation rate is 3 to 4 times higher with TAVR vs surgery. This generates major costs, higher risk of inhospital complications and, at followup, higher tricuspid failure.
Higher implantation or Cusp Overlapping Projection (COP) might solve this inconvenience.
The present study looked at 444 patients undergoing TAVR. 175 of these procedures were done using the CPO technique (39.4%) and the rest, the standard technique.
Even though the populations were similar, there were some differences in age, hypertension, stroke, STS score and the presence of first-degree AV-block.
Read also: Cusp Overlap for Higher CoreValve Implantation.
Mean gradient was 45 mmHg, perimeter was 74 mm and calcium score 2,587 U Agatston.
Procedural success rate was 96%. The most used access was right femoral, 30% required pre-dilation and 30.9% post-dilation.
Mortality was 0.23, stroke 1.1, valve embolization was 0.4, major bleeding was 1.1 and high degree A-V block, 12.2%. There were no differences between the groups but the need for definite pacemaker was lower with COP (12.6 vs. 21.2% (P= 0.02; RR: 0.59; 95% CI: 0.38-0.93)), as was depth measured from the non-coronary cusp to distal prostheses end: 4.2 mm vs.5.14 mm (P=<0.001)
To match the populations researchers used Propensity Score, which left 161 pairs of patients. There were no differences in characteristics, or evolution, which were similar to prior results.
The need for definite pacemaker implantation was lower in the COP population: 11.8% vs 21.7% respectively (P = 0.03; RR: 0.54; 95% CI: 0.32-0.91), aa was mean implantation depth measured from non-coronary sinus 4.2±2.1 mm vs. 5.3±2.6 mm (P < 0.001).
Conclusion
The present study showed that the COP technique significantly reduces the need for pacemaker implantation with self-expandable valves compared to the standard technique, with similar complications rate.
Dr. Carlos Fava.
Member of the Editorial Board, SOLACI.org
Original Title: Permanent Pacemaker Reduction Using Cusp-Overlapping Projection in TAVR A Propensity Score Analysis.
Reference: Isaac Pascual, et al. J Am Coll Cardiol Intv 2022;15:150–161.
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