Key result
The cusp overlap technique significantly reduced the rate of permanent pacemaker implantation (4.3% vs. 18%) compared to the conventional technique in patients undergoing self-expanding valve transcatheter aortic valve replacement.
Why the study?
Managing post-implantation conduction disturbances has become crucial in lower-risk AS patients undergoing TAVR, particularly with self-expanding heart valves.
Does the cusp overlap technique reduce the risk of conduction disturbances and permanent pacemaker implantation in aortic stenosis patients undergoing TAVR with self-expanding valves?
Cohort (n=97)
No
Does the cusp overlap technique reduce the risk of conduction disturbances and permanent pacemaker implantation in aortic stenosis patients undergoing TAVR with self-expanding valves?
The cusp overlap technique during TAVR with self-expanding valves significantly reduces the risk of conduction disturbances, with specific anatomical and procedural factors predicting permanent pacemaker requirement.
COL technique was associated with lower new LBBB and PPI rates; leaves open need for prospective confirmation before changing practice.
Introduction: Since TAVR was approved for lower-risk aortic stenosis (AS) patients, managing post-implantation conduction disturbances has become crucial, especially with self-expanding heart valves (SEV). This study aims to identify risk factors for conduction disturbances in such patients using a specific fluoroscopic cusp overlap (COL) technique. Methods: This retrospective study analyzed AS patients who underwent TAVR with SEV from 2019 to 2022, excluding those needing pacemakers or valve-in-valve procedures. Patients were grouped by conventional (CON) and COL techniques, with outcomes monitored using Valve Academic Research Consortium (VARC)-2 criteria. Results: = 0.033) compared to the CON group. Deeper implantation depth below the non-coronary cusp (NCC) and left coronary cusp (LCC) was linked to an increased risk of conduction disturbances. Multivariate analysis identified smaller left ventricular outflow tract diameter, shorter membranous septum length, and greater pre-releasing implantation depth below the LCC as predictors of future PPI risk. Conclusion: The use of the COL technique significantly reduces the risk of newly developed conduction disturbances after SEV TAVR. Keeping SEV implantation depth within 1 mm of the membranous septum length and maintaining an implantation depth of <6 mm below the LCC before final release further minimizes the risk of PPI.
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Lee et al. (2025) conducted a cohort in Aortic stenosis (n=97). Cusp overlap (COL) technique vs. Conventional three-cusp (CON) technique was evaluated on Permanent pacemaker implantation (PPI) rate at 1 week (p=0.033). The cusp overlap technique significantly reduced the rate of permanent pacemaker implantation (4.3% vs. 18%) compared to the conventional technique in patients undergoing self-expanding valve transcatheter aortic valve replacement.
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