Modifying the implantation technique during transcatheter aortic valve replacement (TAVR) can significantly reduce the risk of permanent pacemaker implantation (PPMI), according to a new analysis published in JACC: Cardiovascular Interventions.
“The standard three-cusp coplanar projection, in which the three coronary cusps are in the same plane, is suitable for deploying balloon-expandable valves,” wrote first author Isaac Pascual, MD, PhD, of the University of Oviedo in Spain, and colleagues. “The transcatheter heart valve (THV) is centered and released in a perpendicular plane to the aortic annulus. On the contrary, self-expanding valves deploy asymmetrically from the noncoronary cusp (NCC) toward the left coronary cusp (LCC). Considering this, a novel implantation technique, the cusp-overlapping projection (COP) technique, is a modification of the classical implantation technique to an overlap of the LCC and the right coronary cusp, isolating the NCC.”
Pascual et al. focused on 444 patients who underwent TAVR with a self-expanding THV at one of two high-volume facilities. All patients were treated from February 2015 to February 2021. Medtronic’s Evolut THV was used in each procedure.
After propensity score matching, the group examined data from 161 matched pairs of patients. While one group underwent TAVR procedures using the COP technique, the second group underwent traditional TAVR procedures. The mean patient ages were 81.8 years old for the COP group and 82.5 years old for the traditional TAVR group.
Overall, the COP technique was associated with a much lower PPMI rate (11.8% vs. 21.7%) compared to the traditional technique and similar rates of complications. PPMI is “one of the most feared complications after TAVR,” the authors wrote, highlighting the importance of their findings.
“This study is hypothesis-generating, and the results need to be confirmed in a randomized trial,” the team added.
Click here to read the full study in JACC: Cardiovascular Interventions.
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