Key result
Cusp-overlap in self-expandable TAVR cuts mortality ~40% and reduces conduction disturbances vs standard technique.
Why the study?
The cusp-overlap technique is an alternative to the standard three-cusp technique in self-expandable TAVR that may improve implantation depth and reduce conduction disturbances, but its overall clinical benefit remains unclear.
Does the cusp-overlap technique reduce mortality, conduction disturbances, and permanent pacemaker implantation compared to the standard three-cusp technique in patients undergoing self-expandable TAVR?
Meta-Analysis (n=7,200)
Does the cusp-overlap technique reduce mortality, conduction disturbances, and permanent pacemaker implantation compared to the standard three-cusp technique in patients undergoing self-expandable TAVR?
The cusp-overlap technique in self-expandable TAVR is associated with reduced short-term mortality and lower rates of conduction disturbances and permanent pacemaker implantation compared to the standard three-cusp technique.
Answers are grounded in this paper and cite their sources.
May support cusp-overlap technique in self-expandable TAVR; extends prior data with mortality and conduction benefit.
Background The cusp-overlap technique (COT) is an alternative fluoroscopic approach to the standard three-cusp technique (ST) in self-expandable transcatheter aortic valve replacement (TAVR). It may improve implantation depth and reduce conduction disturbances, but its overall clinical benefit remains unclear. Objectives To compare the safety and efficacy of COT vs. ST in terms of mortality, conduction disturbances, permanent pacemaker implantation (PPI), and cerebrovascular accidents (CVA). Methods This systematic review and meta-analysis followed PRISMA guidelines. PubMed, Cochrane, Scopus, Embase, and Web of Science were searched up to October 2025. Studies comparing COT and ST were included. Data extraction and risk-of-bias assessment were performed independently. Meta-analysis was conducted using R with fixed- and random-effects models. Outcomes included mortality (by follow-up), conduction disturbances, PPI, and CVA. The protocol was registered in PROSPERO (CRD420251156402). Results Eighteen studies were analyzed, with patient numbers varying by outcome (mortality: 5,984 patients; conduction disturbances: 7,200 patients; PPI: 5,712 patients; CVA: 4,066 patients). COT significantly reduced mortality compared with ST (OR: 0.60, 95% CI: 0.40–0.88; p = 0.010; I 2 = 0%), with the strongest effect observed at 30 days. Conduction disturbances were also lower with COT (OR: 0.62, 95% CI: 0.48–0.82; p = 0.0006; I 2 = 77.7%), driven by reductions in both complete atrioventricular block and left bundle branch block. The risk of PPI was markedly reduced with COT (OR: 0.50, 95% CI: 0.39–0.63; p < 0.0001; I 2 = 23.0%). In contrast, there was no significant difference in CVA between groups (random-effects OR: 1.05, 95% CI: 0.73–1.51; p = 0.78; I 2 = 0%). Conclusion COT in self-expandable TAVR is associated with lower rates of conduction disturbances and PPI, and reduced short-term mortality, without increasing cerebrovascular risk. While these findings are consistent and clinically plausible, the overall certainty of evidence is limited. COT appears to be a promising procedural refinement, but further randomized studies are needed to confirm long-term benefits. Systematic Review Registration identifier CRD420251156402.
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Ghannam et al. (2026) conducted a meta-analysis in Self-expandable transcatheter aortic valve replacement (TAVR) (n=7,200). Cusp-overlap technique (COT) vs. Standard three-cusp technique (ST) was evaluated on Mortality (OR 0.60, 95% CI 0.40-0.88, p=0.010). The cusp-overlap technique in self-expandable TAVR significantly reduced mortality (OR 0.60; 95% CI 0.40-0.88; p=0.010) and conduction disturbances compared to the standard three-cusp technique.
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