Cusp Overlap Technique: Should It Become the Standard Implantation Technique for Self-expanding Valves?

Sengupta, Aditya; Alexis, Sophia L.; Lee, Timothy J.; Zaid, Syed; Krishnamoorthy, Parasuram; Khera, Sahil; Anastasius, Malcolm; Dangas, George; Sharma, Samin K.; Kini, Annapoorna

doi:10.1007/s11886-021-01583-3

Cited by 15 publications

(23 citation statements)

References 34 publications

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“…Unfortunately, modifiable procedural predictors for PPI after TAVR with self-expandable valves are rare [ 20 ]. A COP has been proposed for TAVR with self-expandable valves offering an improved visualization for a more precise valve deployment and recent studies indicated that this implantation technique is associated with a higher implantation depth [ 12 , 13 ].…”

Section: Discussionmentioning

confidence: 99%

“…In our study this rare event occurred in one patient in the COP group (1.6%) indicating a stable valve position using the COP. Despite these positive results, larger studies or meta-analyses with a longer follow-up are needed to confirm this important aspect to assure safety and efficacy of COP compared to TCV [ 13 ].…”

Section: Discussionmentioning

confidence: 99%

“…Recently, a cusp-overlap view (COP) implantation technique has been proposed for the implantation of the self-expandable Core Valve Evolut valve in order to better visualize valve deployment to enhance implantation depth compared to the classical three-cusp view (TCV) [ 12 , 13 ]. Using the COP, the left ventricular outflow tract is elongated, so that the real implantation depth is visualized during valve deployment allowing for higher implantation.…”

Section: Introductionmentioning

confidence: 99%

“…Using the COP, the left ventricular outflow tract is elongated, so that the real implantation depth is visualized during valve deployment allowing for higher implantation. Additionally, COP accentuates the right-non commissure in the center of the fluoroscopic view which further allows for more precise valve implantation [ 13 ]. Two recent studies indicated lower pacemaker rates with comparable procedural and short-term risks after TAVR using the COP [ 11 , 14 ].…”

Section: Introductionmentioning

confidence: 99%

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Transcatheter Aortic Valve Replacement with the Self-Expandable Core Valve Evolut Prosthesis Using the Cusp-Overlap vs. Tricusp-View

Doldi

Stolz

Escher

et al. 2022

JCM

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Despite the rapid increase in experience and technological improvement, the incidence of conduction disturbances in patients undergoing transcatheter aortic valve replacement (TAVR) with the self-expandable CoreValve Evolut valve remains high. Recently, a cusp-overlap view (COP) implantation technique has been proposed for TAVR with self-expandable valves offering an improved visualization during valve expansion compared to the three-cusp view (TCV). This study aims to systematically analyze procedural outcomes of TAVR patients treated with the CoreValve Evolut valve using a COP compared to TCV in a high-volume center. The primary endpoint was technical success according the 2021 VARC-3 criteria. A total of 122 consecutive patients (61 pts. TCV: April 2019 to November 2020; 61 pts. COP: December 2020 to October 2021) that underwent TAVR with the CoreValve Evolut prosthesis were included in this analysis. Although there was no difference in the primary endpoint technical success between TCV and COP patients (93.4% vs. 90.2%, OR 0.65, 95% CI 0.16, 2.4, p = 0.51), we observed a significantly lower risk for permanent pacemaker implantation (PPI) among COP patients (TCV: 27.9% vs. COP: 13.1%, OR 0.39, 95% CI 0.15, 0.97, p = 0.047). Implantation of the CoreValve Evolut prosthesis using the COP might help to reduce the rate of PPI following TAVR.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Transcatheter Aortic Valve Replacement with the Self-Expandable Core Valve Evolut Prosthesis Using the Cusp-Overlap vs. Tricusp-View

Doldi

Stolz

Escher

et al. 2022

JCM

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“…Unlike the standard three-cusp coplanar (TCC) view in which the right coronary cusp (RCC) is in the middle of the left coronary cusp (LCC) and non-coronary cusp (NCC), COP makes the LCC and the RCC overlap in order to eliminate parallax ( Figure 1 ). It helps elongate the left ventricular outflow tract and evaluate the true releasing depth in NCC, thus precisely achieving higher implantation ( 10 ). However, as a new technique, it is uncertain whether COP is actually associated with higher implantation depth, less LBBB, and less PPI after the procedure.…”

Section: Introductionmentioning

confidence: 99%

Comparison of cusp-overlap projection and standard three-cusp coplanar view during self-expanding transcatheter aortic valve replacement: A systematic review and meta-analysis

Chen

Zhu

Liu

et al. 2022

Front. Cardiovasc. Med.

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ObjectivePermanent pacemaker implantation (PPI) is a common complication after transcatheter aortic valve replacement (TAVR). Recently, the cusp-overlap projection (COP) technique was thought to be a feasible method to reduce PPI risk. However, the evidence is still relatively scarce. Therefore, this meta-analysis was performed to compare COP and standard three-cusp coplanar (TCC) projection technique.MethodsPubMed and EMBASE databases were systematically searched for relevant literature published from the inception (EMBASE from 1974 and PubMed from 1966) to 16 April 2022, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. The primary outcome of interest was post-operative (including in-hospital and 30-day) PPI.ResultsTotal of 3,647 subjects from 11 studies were included in this meta-analysis. Of those, 1,453 underwent self-expanding TAVR using COP and 2,194 using TCC technique. In a pooled analysis, the cumulative PPI incidence was 9.3% [95% confidence interval (CI): 6.9–11.7%] and 18.9% (95% CI: 15.5–22.3%) in the COP group and TCC group, respectively. The application of the COP technique was associated with a significant PPI risk reduction (I2 = 40.3% and heterogeneity Chi-square p = 0.070, random-effects OR: 0.49, 95% CI: 0.36–0.66, p < 0.001). A higher implantation depth was achieved in the COP group compared with the TCC group [standardized mean difference (SMD) = −0.324, 95% CI: (−0.469, −0.180)]. There was no significant difference between the two groups in second valve implantation, prosthesis pop-out, fluoroscopic time, post-operative left bundle branch block, mortality, stroke, moderate/severe paravalvular leakage, mean gradient, and length of hospital stay. However, radiation doses were higher in the COP group [SMD = 0.394, 95% CI: (0.216, 0.572), p < 0.001].ConclusionIn self-expanding TAVR, the application of the cusp overlap projection technique was associated with a lower risk of PPI compared with the standard TCC technique.Systematic review registration[https://inplasy.com/inplasy-2022-4-0092/], identifier [INPLASY202240092].

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Impact of implantation technique on conduction disturbances for TAVR with the self‐expanding portico/navitor valve

Wang

Wong

Bajoras

et al. 2022

Cathet Cardio Intervent

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Background: Use of a right−left (R−L) cusp overlap view for transcatheter aortic valve replacement (TAVR) with self-expanding valves has recently been proposed aiming to reduce permanent pacemaker implantation (PPMI). An objective, datadriven explanation for this observation is missing.Aims: To assess the impact of different implantation techniques on the risk of PPMI following TAVR with the Portico/Navitor TM transcatheter heart valve (THV; Abbott).Methods: A TAVR-population treated with Portico/Navitor TM had the THV implanted in a right versus left anterior oblique (RAO/LAO) fluoroscopic view with no parallax in the delivery system. The impact of these different implantation views on the spatial relationship between THV and native aortic annulus and the risk of conduction disturbances and PPMI after TAVR was studied.Results: A total of 366 matched TAVR patients were studied: 183 in the RAO group and 183 in the LAO group. The degree of aortic annulus plane tilt was significantly smaller in the RAO versus LAO group (median: 0°vs. 23°, p < 0.001), with no plane tilt in 105 out of 183 cases (57.3%) in the RAO group. At 30 days after TAVR, the overall PPMI and guideline-directed PPMI rates were 12.6% versus 18.0% (p = 0.15) and 8.2% versus 15.3% (p = 0.04) in the RAO versus LAO group, respectively.Conclusions: Use of a R−L cusp overlap (RAO-caudal) view for implantation of the Portico/Navitor TM valve results in less tilt of the native aortic annulus plane and a clear trend toward a lower 30-day PPMI rate as compared to TAVR using the conventional LAO implantation view.

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Cusp Overlap Technique: Should It Become the Standard Implantation Technique for Self-expanding Valves?

Cited by 15 publications

References 34 publications

Transcatheter Aortic Valve Replacement with the Self-Expandable Core Valve Evolut Prosthesis Using the Cusp-Overlap vs. Tricusp-View

Transcatheter Aortic Valve Replacement with the Self-Expandable Core Valve Evolut Prosthesis Using the Cusp-Overlap vs. Tricusp-View

Comparison of cusp-overlap projection and standard three-cusp coplanar view during self-expanding transcatheter aortic valve replacement: A systematic review and meta-analysis

Impact of implantation technique on conduction disturbances for TAVR with the self‐expanding portico/navitor valve

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