Cusp overlap method for self-expanding transcatheter aortic valve replacement

BackgroundConduction disturbances and the need for permanent pacemaker (PPM) implantation remains a common complication for transcatheter aortic valve replacement (TAVR), particularly when self-expanding (SE) valves are used.AimsWe compared in-hospital and 30-day rates of new PPM implantation between patients undergoing TAVR with SE valves using the conventional three-cusp coplanar implantation technique and the cusp-overlap technique.MethodsWe retrospectively compared patients without a pre-existing PPM who underwent a TAVR procedure with SE Evolut R or PRO valves using the cusp-overlap technique from July 2018 to September 2020 (n = 519) to patients who underwent TAVR using standard three-cusp technique from April 2016 to March 2017 (n = 128) in two high volume Canadian centers.ResultsThere was no significant difference in baseline RBBB between the groups (10.4% vs. 13.2; p = 0.35). The rate of in-hospital new complete heart block (9.4% vs. 23.4%; p <= 0.001) and PPM implantation (8% vs. 21%; p <= 0.001) were significantly reduced when using the cusp-overlap technique. The incidence of new LBBB (30.4% vs. 29%; p = 0.73) was similar. At 30 days, the rates of new complete heart block (11% vs. 23%; p <= 0.001) and PPM implantation (10% vs. 21%, p <= 0.001) remained significantly lower in the cusp-overlap group, while the rate of new LBBB (35% vs. 30%; p = 0.73) was similar.ConclusionCusp-overlap approach offers several potential technical advantages compared to standard three-cusp view, and may result in lower PPM rates in TAVR with SE Evolut valve.

Automated summary

This study compared the rates of new PPM implantation between patients undergoing TAVR with self-expanding valves using the conventional three-cusp technique and the cusp-overlap technique. The results showed that the cusp-overlap technique significantly reduced the rates of complete heart block and PPM implantation during hospitalization and at 30 days compared to the standard three-cusp technique.