Cusp‐overlap versus coplanar view in transcatheter aortic valve implantation with self‐expandable valves: A meta‐analysis of comparative studies

Abstract

Background Permanent pacemaker implantation (PPI) is a common complication after transcatheter aortic valve implantation (TAVI). The cusp‐overlap view (COV) was adopted to reduce PPI risk after TAVI with self‐expandable valves (SEVs); however, the evidence remains scarce. We performed a systematic review with meta‐analysis comparing COV and the standard coplanar view (CPV) technique to evaluate their effectiveness and safety. Methods Following the PRISMA statement, data were extracted from studies published by August 2022 and found in PubMed/MEDLINE, EMBASE, CENTRAL/CCTR, http://ClinicalTrials.gov, SciELO, LILACS, and Google Scholar. The primary outcome of interest was post‐procedural PPI and the secondary outcomes were new left bundle branch block (LBBB), moderate/severe paravalvular leak (PVL), valve dislocation (pop‐out); need of second transcatheter heart valve, 30‐day mortality, stroke, conversion to surgery, coronary obstruction, implantation depth (mm), and post‐TAVI mean gradients (mmHg). Results Eleven studies met our eligibility criteria and included 1464 patients in the COV group and 1743 patients in the CPV group. Patients who underwent TAVI with COV had lower risk of PPI (odds ratio 0.48; 95% confidence interval [CI] 0.33–0.70; p = 0.001) and higher implantation depths with COV (mean difference −0.83; 95% CI −1.2 to −0.45; p < 0.001). We did not observe any statistically significant differences in the rates of new LBBB, moderate/severe PVL, valve dislocation, need of second transcatheter heart valve, 30‐day mortality, stroke, conversion to surgery, coronary obstruction, and post‐TAVI mean gradients (mmHg). Conclusion In TAVI with SEVs, the application of COV is associated with lower risk of PPI compared with the standard CPV without increasing risk for adverse outcomes.

Computed tomography‐derived membranous septum length as predictor of conduction abnormalities and permanent pacemaker implantation after TAVI: A meta‐analysis of observational studies

“…Nevertheless, we could not leave unmentioned the fact that repositionable self‐expanding THVs give operators the chance of recapturing and redeploying the valves with optimal IDs in case these are deployed overly deep or overly shallow at first, which helps avoid both CA/PPI and pop‐outs. Furthermore, in TAVI with SEVs, the application of cusp‐overlap view is associated with lower risk of PPI compared with the standard coplanar view 38 …”

Impact of New‐Onset Right Bundle‐Branch Block After Transcatheter Aortic Valve Replacement on Permanent Pacemaker Implantation

“… 40 , 41 , 42 , 43 As factors associated with the TAVR procedure, pre‐ and post‐balloon dilatation have been reported as predictors of PPI. 44 The cusp overlap technique for TAVR with self‐expanding valves is effective as a procedural technique to reduce the rate of PPI through deployment with optimal implantation depth compared with the standard technique using a coplanar view 45 , 46 ; however, the rate of cusp overlap technique was low in our study population. Moreover, implantation depth is associated with new conduction disturbances after TAVR.…”

Factors Influencing Implantation Depth During Transcatheter Aortic Valve Replacement

“…13,14 Application of the COT was shown to be associated with significantly lower PPI rates in several studies and current meta-analyses. [15][16][17][18][19][20][21] Furthermore, the symmetry of the implanted THV might be improved because of antegrade positioning, better visualisation of the non-coronary cusp nadir and accurate assessment of the actual device depth without foreshortening of the LVOT. 17 Even if the COT was established for specific self-expandable valves due to their greater extension into the LVOT, it has already been shown how this technique might influence ID, PPI need, and haemodynamic performance using balloon-expandable and other devices.…”