Benefit of Cusp overlap method for self‐expanding transcatheter aortic valves

The need for permanent pacemaker implantation (PPM) continues to be one of the main challenges in TAVR, especially with self-expanding valves, with a pacemaker implantation rate that varies between 17.5% and 30% in large randomized studies, vs. 4% to 6.5% with self-expanding valves.

Beneficio del implante alto de las válvulas aórticas percutáneas autoexpandibles 

Therefore, in an attempt to prevent the need for PPM implantation, the cusp overlapping technique has been developed (COT) which several analysts have shown has a lower rate vs the conventional implantation technique also called three cusp technique (3C). However, at present, this technique still calls for robust, large randomized trials. 

This study looked at 647 patients undergoing TAVR with self-expanding EVOLUT; 519 (80.2%) with the COT technique.

Both groups were similar, with mean age 82, but surgical scores were higher in those treated with the 3C technique. 

Left ventricular function was higher in COT patients (58% vs. 53%, p<0.001), with 41 mmHg gradient and close to 2% bicuspid valves. 

Read also: Does Post-Dilation in TAVR Affect its Long-Term Outcomes?

Valve 29 was the most used (45%), followed by the 26 (35%), and 34 (12%) and, in lower numbers, the 23; the transfemoral approach was used in nearly all patients.

At 30 days, patients treated with the COT technique showed lower need for PPM implantation (10% vs. 21%, p=<0.001) and one new AV block (11% vs. 23%, p<0.001), with no difference in new intraventricular conduction block. 

Conclusion

COT presents some potential technical advantages vs. 3C, and perhaps a lower rate of PPM implantation in TAVR with self-expanding EVOLUT. 

Dr. Carlos Fava - Consejo Editorial SOLACI

Dr. Carlos Fava.
Member of the Editorial Board of SOLACI.org.

Original Title: Cusp overlap method for self‐expanding transcatheter aortic valve replacement.

Reference: Talal F. Aljabbary, et al. Catheter Cardiovasc Interv. 2024;103:202–208.


Subscribe to our weekly newsletter

Get the latest scientific articles on interventional cardiology

More articles by this author

Unplanned Coronary Angiography After TAVR: Incidence, Predictors, and Outcomes

The importance of assessing coronary artery disease in patients undergoing transcatheter aortic valve replacement (TAVR) is well recognized due to the high prevalence of...

TAVR Unload: TAVR in Moderate Aortic Stenosis and Ventricular Function Deterioration

Aortic Stenosis (AS) significantly contributes to valvulo-arterial impedance in patients with heart failure and reduced ejection fraction (HFrEF), making it a relevant therapeutic target...

TAVI and Hypertrophic Cardiomyopathy: An Increasingly Common Association

Stenosis is a common disease affecting 5% of the elderly population. It is associated with hospitalizations, poor quality of life, and mortality.  The association between...

TAVR in Bicuspid Valves: Higher Prosthesis Mismatch?

TAVR indication is steadily advancing onto younger, lower risk patients.  The presence of bicuspid aortic valves (BAV) has been observed in 0.5% to 2% of...

LEAVE A REPLY

Please enter your comment!
Please enter your name here

Related Articles

SOLACI Sessionsspot_img

Recent Articles

Unplanned Coronary Angiography After TAVR: Incidence, Predictors, and Outcomes

The importance of assessing coronary artery disease in patients undergoing transcatheter aortic valve replacement (TAVR) is well recognized due to the high prevalence of...

Intravascular Lithotripsy in Calcified Coronary Lesions: Success Predictors

Coronary artery calcification (CAC) is increasingly common in patients undergoing percutaneous coronary intervention (PCI). Intravascular lithotripsy (IVL) has been established as an effective tool...

TAVR Unload: TAVR in Moderate Aortic Stenosis and Ventricular Function Deterioration

Aortic Stenosis (AS) significantly contributes to valvulo-arterial impedance in patients with heart failure and reduced ejection fraction (HFrEF), making it a relevant therapeutic target...