Key result
Cusp-overlap technique fails to reduce 30-day HAVB or PPI vs three-cusp coplanar technique.
Why the study?
New-onset conduction disturbances after TAVI remain common and are influenced by implantation depth relative to patient-specific anatomy, particularly membranous septum length.
Does the cusp-overlap projection technique reduce the composite of high-degree atrioventricular block or permanent pacemaker implantation at 30 days in patients undergoing TAVI compared to the conventional three-cusp coplanar technique?
Cohort (n=501)
No
Does the cusp-overlap projection technique reduce the composite of high-degree atrioventricular block or permanent pacemaker implantation at 30 days in patients undergoing TAVI compared to the conventional three-cusp coplanar technique?
The cusp-overlap technique during TAVI results in higher valve implantation depth but does not independently reduce the 30-day risk of high-degree AV block or permanent pacemaker implantation compared to the conventional coplanar technique.
Routine cusp-overlap should not be adopted to reduce PPM after TAVI; challenges observational enthusiasm and leaves randomized evaluation open.
New-onset conduction disturbances (NOCD) including high-degree atrioventricular block (HAVB), permanent pacemaker implantation (PPI) and new-onset left bundle branch block after transcatheter aortic valve implantation (TAVI) remain common and are influenced by implantation depth (ID) relative to patient-specific anatomy, particularly membranous septum length.To compare the cusp-overlap (COL) and conventional three-cusp coplanar (TCC) projection techniques with a focus on ID relative to membranous septum length and its association with conduction outcomes. A total of 501 patients undergoing TAVI with pre-procedural multidetector computed tomography were included. The primary endpoint was a composite of HAVB or PPI at 30 days. ID was measured on the final angiography. Propensity score overlap weighting analysis was performed to assess the effects of COL on ID and the main outcome.COL was significantly associated with higher valve implantation (ID 4.0 ± 1.95 mm vs. 5.54 ± 2.6 mm; β coefficient = -1.76; 95% CI: -2.24 to -1.26). The primary endpoint occurred at similar rates in both groups (15% vs. 19%; p = 0.24), and COL was not independently associated with the primary outcome (OR 0.63, 95% CI 0.36–1.12). Deeper implantation was associated with the primary outcome (4.66 ± 2.33 mm vs. 6.56 ± 2.66 mm; p < 0.01). A greater difference between membranous septum length and ID independently predicted lower event risk.COL was not independently associated with reduced NOCD but may facilitate higher implantation relative to membranous septum length, supporting an individualized, anatomy-guided implantation strategy.
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Lemarchand et al. (2026) conducted a cohort in Symptomatic aortic valve stenosis (n=501). Cusp-overlap (COL) technique vs. Three-cusp coplanar (TCC) technique was evaluated on Composite of high-degree atrioventricular block (HAVB) or permanent pacemaker implantation (PPI) at 30 days (OR 0.63, 95% CI 0.36-1.12, p=0.12). The cusp-overlap technique did not significantly reduce the composite of high-degree atrioventricular block or permanent pacemaker implantation at 30 days (15% vs 19%, OR 0.63) compared to the three-cusp coplanar technique.
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