Transcatheter aortic valve replacement (TAVR) has been proving its benefit in different scenarios for two decades now. However, in the field of self-expanding valves, one challenge has always been its high rate of pacemaker implantation compared with balloon-expandable devices and valvular replacement surgery.
For this reason, the high implantation or Cusp Overlapping strategy was developed. This alternative has demonstrated in different analyses a lower need for definitive pacemaker after implantation, but to date there are only small studies and no randomized or large studies.
Researchers conducted a meta-analysis of 11 (non-randomized) studies, which included 3207 patients. Of them, 1464 (45.6%) had a Cusp Overlapping (COVL), while 1743 had a tricuspid coplanar implantation (COP).
The primary endpoint (PEP) was permanent pacemaker implantation.
The PEP was in favor of the COVL group (odds ratio: 0.48; 95% confidence interval [CI]: 0.33-0.70; p = 0.001). Among these patients, there was also a higher implant compared with the COP group (mean difference: -0.83; 95% CI: -1.2 to -0.45; p < 0.001).
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There was no statistically significant difference regarding the presence of new left bundle branch block, moderate or severe paravalvular leak, need for a second valve, stroke, mortality, crossover to surgery, coronary obstruction, and gradient after implantation.
Conclusion
In TAVR with self-expandable valves, implantation with COVL was associated with lower risk of definitive pacing compared with the COP strategy, with no increased risk of adverse events.
Dr. Carlos Fava.
Member of the Editorial Board of SOLACI.org.
Reference: Michel Pompeu Sá, et al. Catheter Cardiovasc Interv. 2023;101:639–650.
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