E-49 | PROTECT-PACE: Pacemaker Reduction with cusp Overlap TEchnique in Conduction-Compromised TAVR Patients using Balloon Expandable Valves

Despite newer valve designs, permanent pacemaker implantation (PPI) rates remain high, between 12% to 36% in patients undergoing TAVR. PPI rates should be even higher in the subset of those with pre-existing conduction abnormalities. The cusp-overlap technique (COT) has shown potential in lowering PPI with self-expanding valves (SEV). This is the first study examining the rate of PPI in patients with pre-existing electrical disorders undergoing TAVR with Balloon expandable valves BEV using COT. We analyzed 101 patients from 5/21-12/22 who underwent TAVR with Edwards Sapien BEV. 30 met criteria of having pre-TAVR EKG with conduction abnormalities, COT deployment, EKG pre discharge, and 30 day follow up. Patients with prior pacemakers, valve in valve cases, and those lost to 30-day follow-up were excluded. Statistical tests (Wilcoxon Signed Rank and paired t-test) assessed LVEF, gradients, and KCCQ with p < 0.05 as significance level. Mean age was 77.81 + 8.86, AVA 0.70 + 0.23, EuroSCORE II: 3.77+3.55), Ca2+ Score 3580.12 + 2278.25 AU. All had pre-TAVR conduction abnormalities as per Fig. 1. Post-TAVR 1 patient has mild aortic insufficiency (AI), 12 trace, and 16 no AI. Despite this being a very high-risk group for PPI, only 1 patient (3.33%) required post-TAVR pacemaker. Our small study exploring COT for BEV TAVR in patients with pre-existing conduction abnormalities showed promising outcomes. Achieving a rate of 3.33% in this high risk for PPI group signals the potential role for COT to be adopted as the standard deployment view when utilizing BEV in this patient cohort. Larger studies are needed to definitively establish this.