Key result
Higher TAVR implantation depth links to ~89% lower 1-year PPI risk versus deeper placement.
Why the study?
Standardized implant protocols show promise in improving TAVR outcomes, but the impact of implant depth on clinical outcomes remains unclear.
Does higher TAVR device implantation depth improve clinical and hemodynamic outcomes in patients with symptomatic severe aortic stenosis?
Cohort (n=603)
Yes
Does higher TAVR device implantation depth improve clinical and hemodynamic outcomes in patients with symptomatic severe aortic stenosis?
Absolute Event Rate: 2.3% vs 20.3%
p-value: p=<.001
Higher TAVR implantation depth significantly reduces the need for permanent pacemaker implantation and shortens hospital stay without increasing the risk of valve migration, stroke, or mortality.
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Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
“The proximity of the prosthesis frame to the membranous septum and conduction system has been shown to be strongly depth-dependent, supporting a strategy of higher implantation to minimize mechanical interaction with the atrioventricular conduction tissue.”
“We are encouraged by this data as it demonstrates significant positive outcomes when leveraging the cusp overlap technique with the Evolut valve. The new results support a standardized protocol that will help support early hospital discharge and lower rates of complications for our patients, improving their quality of life.”
“The results demonstrate significant improvement for TAVR with the Evolut valve, some of the best results in an Evolut trial we have ever seen. Adopting the cusp overlap technique and clinical pathways resulted in single-digit pacemaker rates out to 30 days, next-day discharge in the majority of the patients, and remarkably low rates of paravalvular leak.”
Higher TAVR implant depth may reduce pacemaker implantation; randomized trials needed before practice change.
UNLABELLED: (350/350) BACKGROUND: Standardized implant protocols have shown promise in improving outcomes in transcatheter aortic valve replacement (TAVR). However, the impact of implant depth on clinical outcomes remains unclear. OBJECTIVES: To evaluate clinical and hemodynamic outcomes across varying TAVR implantation depths using data from the Optimize PRO study. METHODS: This prospective, multicenter Optimize PRO study included patients with symptomatic severe aortic stenosis undergoing TAVR with Evolut PRO/PRO+ systems. Patients were stratified by core laboratory-adjudicated non-coronary cusp implant depth. The echocardiographic outcome composite included none/trace paravalvular regurgitation, aortic mean gradient ≤10mmHg and no prosthesis-patient-mismatch at discharge. RESULTS: Patients (N=603) were stratified by implant depth: <1mm (N=88), 1 to ≤3mm (N=196), >3 to ≤5mm (N=170), and >5mm (N=149). Baseline characteristics were similar across implant depth groups, except for a higher proportion of females in higher implant depths. Higher implant depths were associated with less resheathing and recapture (27.3% [24/88], 33.7% [66/196], 48.8% [83/170], 51.7% [77/149]; P<.001), and shorter median [Q1, Q3] hospital stay (days: 1[1,1], 1[1,2], 2 [1,3], 2 [1,4]; P<.001). Rates of valve migration (0% [95% CI:NA], 0.5% [95% CI:0.1-3.6], 0.6% [95% CI:0.1-4.1], 1.3% [95% CI:0.3-5.3]; P=.63) were low across implant depth groups. The 1-year all-cause mortality or all-stroke rate was comparable across implant depth groups (8.1% [95% CI:3.9-16.2], 7.2% [95% CI:4.3-11.8], 10.7% [95% CI:6.9-16.5], 12.5% [95% CI:8.1-19.2]; P=.40). After 1 year, higher implant depths were associated with lower rates of permanent pacemaker implantation (PPI, 2.3% [95% CI:0.6-8.8], 9.2% [95% CI:5.9-14.3], 15.9% [95% CI:11.2-22.4], 20.3% [95% CI:14.6-27.7]; P<.001). Rates of New York Heart Association functional class I were numerically different across implant depth groups but did not reach statistical significance (NYHA, 77.8% [56/72], 71.8% [130/181], 65.2% [101/155], 67.7% [84/124], P=.09 across all classes). In males, echo outcome composite rates were not statistically different across depth groups (58.6%[17/29], 50.6% [39/77], 43.8% [35/80], 36.1% [26/72]; P=.14), although the exploratory trend test reached statistical significance (P=.02). CONCLUSIONS: Higher TAVR device implantation was associated with improved clinical outcomes with similar safety events, including valve migration, across depths. The long-term effect of this approach including the ability to perform redo-TAVR safely, will be further studied in the future.
Dvir et al. (2026) conducted a cohort in Symptomatic severe aortic stenosis (n=603). Higher TAVR implantation depth (<1mm) vs. Deeper TAVR implantation (>5mm) was evaluated on Permanent pacemaker implantation (PPI) after 1 year (p=<.001). Higher TAVR implantation depth (<1mm) was associated with lower rates of permanent pacemaker implantation at 1 year compared to >5mm depth (2.3% vs 20.3%; P<0.001), with similar mortality and stroke.
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