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      Cusp-overlap view reduces conduction disturbances and permanent pacemaker implantation after transcatheter aortic valve replacement even with balloon-expandable and mechanically-expandable heart valves

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          Abstract

          Background

          Conduction disturbances demanding permanent pacemaker implantation (PPI) remain a common complication after transcatheter aortic valve replacement (TAVR). Optimization of the implantation depth (ID) by introducing the cusp-overlap projection (COP) technique led to a reduced rate of PPI when self-expanding valves were used.

          Objectives

          The aim of the present study was to determine if using the novel COP view is applicable for all types of TAVR prosthesis and results in a higher ID and reduced incidence of new conduction disturbances and PPI.

          Methods

          In this prospective case-control study 586 consecutive patients undergoing TAVR with either balloon-expandable Edwards SAPIEN S3 ( n = 280; 47.8%), or mechanically expandable Boston LOTUS Edge heart valve prostheses ( n = 306; 52.2%) were included. ID as well as rates of periprocedural PPI and left bundle branch block (LBBB) were compared between the conventional three-cusp coplanar (TCC) projection and the COP view for implantation.

          Results

          Of 586 patients, 282 (48.1%) underwent TAVR using COP, whereas in 304 patients (51.9%) the TCC view was applied. Using COP a significantly higher ID was achieved in Edwards SAPIEN S3 TAVR procedures (ID mean difference −1.0 mm, 95%−CI −1.9 to −0.1 mm; P = 0.029), whereas the final platform position did not differ significantly between both techniques when a Boston LOTUS Edge valve was used (ID mean difference −0.1 mm, 95%-CI −1.1 to +0.9 mm; P = 0.890). In Edwards SAPIEN S3 valves, higher ID was associated with a numerically lower post-procedural PPI incidence (4.9% vs. 7.3%; P = 0.464). Moreover, ID was significantly deeper in patients requiring PPI post TAVR compared to those without PPI [8.7 mm (6.8–10.6 mm) vs. 6.5 mm (6.1–7.0 mm); P = 0.005]. In Boston LOTUS Edge devices, COP view significantly decreased the incidence of LBBB post procedure (28.1% vs. 47.9%; P < 0.001), while PPI rates were similar in both groups (21.6% vs. 25.7%; P = 0.396).

          Conclusion

          The present study demonstrates the safety, efficacy and reproducibility of the cusp-overlap view even in balloon-expandable and mechanically-expandable TAVR procedures. Application of COP leads to significantly less LBBB in repositionable Boston LOTUS Edge valves and a numerically lower PPI rate in Edwards SAPIEN S3 valves post TAVR compared to the standard TCC projection. The results should encourage to apply the COP view more widely in clinical practice.

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          Most cited references45

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          Transcatheter Aortic-Valve Replacement with a Balloon-Expandable Valve in Low-Risk Patients

          Michael J Mack, Martin Leon, Vinod H Thourani … (2019)
          Among patients with aortic stenosis who are at intermediate or high risk for death with surgery, major outcomes are similar with transcatheter aortic-valve replacement (TAVR) and surgical aortic-valve replacement. There is insufficient evidence regarding the comparison of the two procedures in patients who are at low risk.
          Article 0 comments Cited 1031 times – based on 0 reviews     Review now
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            2021 ESC/EACTS Guidelines for the management of valvular heart disease

            Alec Vahanian, Friedhelm Beyersdorf, Fabien Praz … (2022)
            Article 0 comments Cited 978 times – based on 0 reviews     Review now
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              Transcatheter Aortic-Valve Replacement with a Self-Expanding Valve in Low-Risk Patients

              Jeffrey J. Popma, G Deeb, Steven J Yakubov … (2019)
              Transcatheter aortic-valve replacement (TAVR) is an alternative to surgery in patients with severe aortic stenosis who are at increased risk for death from surgery; less is known about TAVR in low-risk patients.
              Article 0 comments Cited 782 times – based on 0 reviews     Review now
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                Author and article information

                Contributors
                Tilman Stephan: URI : https://loop.frontiersin.org/people/2364175/overviewRole: Role: Role: Role: Role: Role: Role: Role: Role:
                Marvin Krohn-Grimberghe: URI : https://loop.frontiersin.org/people/2337303/overviewRole: Role: Role: Role: Role: Role: Role: Role: Role:
                Christoph Buck: Role: Role: Role: Role:
                Michael Baumhardt: URI : https://loop.frontiersin.org/people/1286080/overviewRole: Role: Role: Role:
                Johannes Mörike: URI : https://loop.frontiersin.org/people/1348346/overviewRole: Role: Role: Role:
                Birgid Gonska: URI : https://loop.frontiersin.org/people/1400002/overviewRole: Role: Role: Role: Role: Role:
                Wolfgang Rottbauer: URI : https://loop.frontiersin.org/people/1226929/overviewRole: Role: Role: Role:
                Dominik Buckert: URI : https://loop.frontiersin.org/people/1355559/overviewRole: Role: Role: Role: Role: Role: Role: Role: Role: Role:
                Journal
                Journal ID (nlm-ta): Front Cardiovasc Med
                Journal ID (iso-abbrev): Front Cardiovasc Med
                Journal ID (publisher-id): Front. Cardiovasc. Med.
                Title: Frontiers in Cardiovascular Medicine
                Publisher: Frontiers Media S.A.
                ISSN (Electronic): 2297-055X
                Publication date (Electronic): 01 December 2023
                Publication date Collection: 2023
                Volume: 10
                Electronic Location Identifier: 1269833
                Affiliations
                Department of Cardiology, Angiology, Pneumology and Internal Intensive Care, University of Ulm , Ulm, Germany
                Author notes

                Edited by: Luca Testa, IRCCS San Donato Polyclinic, Italy

                Reviewed by: Damiano Regazzoli, Humanitas Research Hospital, Italy Ivan Wong, Queen Elizabeth Hospital (QEH), China Kendra J. Grubb, Emory University, United States

                [* ] Correspondence: Dominik Buckert dominik.buckert@ 123456uniklinik-ulm.de
                [ † ]

                These authors have contributed equally to this work and share first authorship

                Abbreviations CI, Confidence interval; COP, cusp-overlap projection; CT, computed tomography; ECG, electrocardiogram; ID, implantation depth; LBBB, left bundle branch block; LCC/NCC/RCC, left-/non-/right-coronary cusp; LVOT, left ventricular out-flow tract; PPI, permanent pacemaker implantation; RBBB, right bundle branch block; TAVR, transcatheter aortic valve implantation; TCC, three-cusp coplanar projection.

                Article
                DOI: 10.3389/fcvm.2023.1269833
                PMC ID: 10722163
                PubMed ID: 38107259
                SO-VID: c4673534-468a-4c60-86ef-bd8d43f9999d
                Copyright © © 2023 Stephan, Krohn-Grimberghe, von Lindeiner genannt von Wildau, Buck, Baumhardt, Mörike, Gonska, Rottbauer and Buckert.
                License:

                This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

                History
                Date received : 30 July 2023
                Date accepted : 30 October 2023
                Page count
                Figures: 5, Tables: 2, Equations: 0, References: 45, Pages: 0, Words: 0
                Funding
                Funded by: The author(s) declare that no financial support was received for the research, authorship, and/or publication of this article.
                The author(s) declare that no financial support was received for the research, authorship, and/or publication of this article.
                Categories
                Subject: Cardiovascular Medicine
                Subject: Original Research
                Custom metadata
                section-at-acceptance Heart Valve Disease

                Keywords: implantation technique,permanent pacemaker implantation,tavr,transcatheter aortic valve replacement,aortic stenosis,conduction disturbance,cusp-overlap projection,implantation depth
                Data availability:
                Keywords: implantation technique, permanent pacemaker implantation, tavr, transcatheter aortic valve replacement, aortic stenosis, conduction disturbance, cusp-overlap projection, implantation depth

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