Snare-assisted self-expanding TAVR achieved comparable 30-day device success to standard TAVR and reduced new permanent pacemaker implantation in type-0 bicuspid patients (3.3% vs. 18.3%, p=0.01).
Cohort (n=766)
Does the snare-assisted technique improve safety and device success in patients undergoing transfemoral self-expanding TAVR for aortic stenosis with complex anatomies?
The snare-assisted technique is a safe and effective adjunct for self-expanding TAVR in complex, angulated aortic anatomies, yielding comparable device success and potentially reducing pacemaker rates in type-0 bicuspid valves.
The snare-assisted technique has been described to facilitate transcatheter aortic valve replacement (TAVR) delivery system advancement in complex aortic anatomies. However, the evidence is limited to case reports. To evaluate the safety profile of the snare-facilitated approach and its impact on self-expanding (SE) TAVR outcomes, we collected consecutive patients who underwent transfemoral SE-TAVR for aortic stenosis, using propensity score matching (PSM) separately in tricuspid and type-0 and type-1 bicuspid aortic valve morphology between the snare and non-snare groups. In 766 patients, despite the snare group having significantly larger annulus angulation and maximal ascending aortic diameter, both groups achieved comparable 30-day device success rates, regardless of first-generation or new-generation valve use. After PSM, the snare group had a significantly lower new permanent pacemaker implantation rate among 193 type-0 patients (3.3% vs. 18.3%, p = 0.01). The ipsilateral group used new-generation valves less frequently (23.0% vs. 75.4%, p < 0.001), but there were no significant inter-group differences in procedure-related events, except for a lower incidence of PVL ≥ mild in the ipsilateral group (14.9% vs. 32.3%, p = 0.01). In conclusion, the snare-assisted technique appears useful in SE-TAVR with angulated aortic root anatomy, and the benefits were comparable between ipsilateral and contralateral snare techniques.
Yao et al. (Tue,) conducted a cohort in Aortic stenosis (n=766). Snare-assisted technique vs. Non-snare technique was evaluated on 30-day device success rates. Snare-assisted self-expanding TAVR achieved comparable 30-day device success to standard TAVR and reduced new permanent pacemaker implantation in type-0 bicuspid patients (3.3% vs. 18.3%, p=0.01).