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Aljabbary TF, Komatsu I, Ochiai T, Fremes SE, Ali N, Burke L, Peterson MD, Fam NP, Wijeysundera HC, Radhakrishnan S. Cusp overlap method for self-expanding transcatheter aortic valve replacement. Catheter Cardiovasc Interv 2024; 103:202-208. [PMID: 38009641 DOI: 10.1002/ccd.30910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 10/27/2023] [Indexed: 11/29/2023]
Abstract
BACKGROUND Conduction disturbances and the need for permanent pacemaker (PPM) implantation remains a common complication for transcatheter aortic valve replacement (TAVR), particularly when self-expanding (SE) valves are used. AIMS We compared in-hospital and 30-day rates of new PPM implantation between patients undergoing TAVR with SE valves using the conventional three-cusp coplanar implantation technique and the cusp-overlap technique. METHODS We retrospectively compared patients without a pre-existing PPM who underwent a TAVR procedure with SE Evolut R or PRO valves using the cusp-overlap technique from July 2018 to September 2020 (n = 519) to patients who underwent TAVR using standard three-cusp technique from April 2016 to March 2017 (n = 128) in two high volume Canadian centers. RESULTS There was no significant difference in baseline RBBB between the groups (10.4% vs. 13.2; p = 0.35). The rate of in-hospital new complete heart block (9.4% vs. 23.4%; p ≤ 0.001) and PPM implantation (8% vs. 21%; p ≤ 0.001) were significantly reduced when using the cusp-overlap technique. The incidence of new LBBB (30.4% vs. 29%; p = 0.73) was similar. At 30 days, the rates of new complete heart block (11% vs. 23%; p ≤ 0.001) and PPM implantation (10% vs. 21%, p ≤ 0.001) remained significantly lower in the cusp-overlap group, while the rate of new LBBB (35% vs. 30%; p = 0.73) was similar. CONCLUSION Cusp-overlap approach offers several potential technical advantages compared to standard three-cusp view, and may result in lower PPM rates in TAVR with SE Evolut valve.
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Affiliation(s)
- Talal F Aljabbary
- Schulich Heart Program, Sunnybrook Health Sciences Center, University of Toronto, Toronto, Canada
- Department of Cardiac Sciences, King Fahad Cardiac Center, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Ikki Komatsu
- Department of Cardiology, Tokyo Medical University Hospital, Tokyo, Japan
| | - Tomoki Ochiai
- Schulich Heart Program, Sunnybrook Health Sciences Center, University of Toronto, Toronto, Canada
- Department of Cardiology, Shonan Kamakura General Hospital, Kamakura, Kanagawa, Japan
| | - Stephen E Fremes
- Schulich Heart Program, Sunnybrook Health Sciences Center, University of Toronto, Toronto, Canada
| | - Noman Ali
- Division of Cardiology, Terrence Donnelly Heart Center, St. Michael's Hospital, Unity Health Toronto, University of Toronto, Toronto, Ontario, Canada
| | - Lucas Burke
- Division of Cardiology, Terrence Donnelly Heart Center, St. Michael's Hospital, Unity Health Toronto, University of Toronto, Toronto, Ontario, Canada
| | - Mark D Peterson
- Division of Cardiology, Terrence Donnelly Heart Center, St. Michael's Hospital, Unity Health Toronto, University of Toronto, Toronto, Ontario, Canada
| | - Neil P Fam
- Division of Cardiology, Terrence Donnelly Heart Center, St. Michael's Hospital, Unity Health Toronto, University of Toronto, Toronto, Ontario, Canada
| | - Harindra C Wijeysundera
- Schulich Heart Program, Sunnybrook Health Sciences Center, University of Toronto, Toronto, Canada
| | - Sam Radhakrishnan
- Schulich Heart Program, Sunnybrook Health Sciences Center, University of Toronto, Toronto, Canada
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Akodad M, Blanke P, Nestelberger T, Alosail A, Chatfield AG, Chuang MYA, Leipsic JA, Tzimas G, Lounes Y, Meier D, Sathananthan J, Wood DA, Webb JG. Hybrid Approach Using the Cusp-Overlap Technique for Transcatheter Aortic Valve Replacement With a Balloon-Expandable Valve. JACC Cardiovasc Interv 2022; 15:2387-2395. [PMID: 36402718 DOI: 10.1016/j.jcin.2022.10.035] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 09/23/2022] [Accepted: 10/21/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND The cusp-overlap (CO) technique has recently been advocated and is being increasingly adopted for self-expandable transcatheter heart valve (THV) implantation. OBJECTIVES The aim of this study was to evaluate the feasibility, implantation depth, and outcomes of the CO technique for the balloon-expandable SAPIEN 3 THV. METHODS The CO technique was used in consecutive patients undergoing balloon-expandable THV implantation at one center between April 2021 and March 2022. Optimal fluoroscopic angles were determined from preprocedural computed tomography and confirmed on predeployment angiography. The THV radiolucent line was positioned 2 to 4 mm below the noncoronary cusp in the CO view, and positioning was confirmed in the 3-cusp view. Postdeployment THV implantation depth was assessed in both views. One-month outcomes were assessed using Valve Academic Research Consortium 3 criteria. RESULTS Among 137 patients eligible for the CO technique, the CO view was not used because of unfavorable ergonomics in 27 patients (26.5%) and hemodynamic instability in 8 patients (7.8%). Among 102 patients, the mean age was 81.1 ± 6.6 years, the mean Society of Thoracic Surgeons score was 3.3% ± 2.2%, and 64.7% were men. The mean measured THV implantation depth was 3.0 ± 1.4 mm in the CO view and 2.5 ± 1.4 mm in the 3-cusp view. At 1-month follow-up, 1 patient (1.0%) had died, 1 (1.0%) had had a stroke, and 7 (6.8%) had undergone permanent pacemaker implantation. CONCLUSIONS The CO technique is feasible and safe and may facilitate more accurate balloon-expandable THV positioning, especially when deep implantation needs to be avoided. Further studies are required to explore potential reduction in atrioventricular conduction block, pacemakers, or paravalvular regurgitation.
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Affiliation(s)
- Mariama Akodad
- Centres for Heart Valve Innovation and for Cardiovascular Innovation, St. Paul's and Vancouver General Hospitals, Vancouver, British Columbia, Canada; Division of Cardiology, University of British Columbia & St. Paul's Hospital, Vancouver, British Columbia, Canada; Cardiovascular Translational Laboratory, Centre for Heart Lung Innovation, University of British Columbia & St. Paul's Hospital, Vancouver, British Columbia, Canada
| | - Philipp Blanke
- Department of Radiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Thomas Nestelberger
- Centres for Heart Valve Innovation and for Cardiovascular Innovation, St. Paul's and Vancouver General Hospitals, Vancouver, British Columbia, Canada; Division of Cardiology, University of British Columbia & St. Paul's Hospital, Vancouver, British Columbia, Canada
| | - Abdulmajeed Alosail
- Centres for Heart Valve Innovation and for Cardiovascular Innovation, St. Paul's and Vancouver General Hospitals, Vancouver, British Columbia, Canada; Division of Cardiology, University of British Columbia & St. Paul's Hospital, Vancouver, British Columbia, Canada
| | - Andrew G Chatfield
- Centres for Heart Valve Innovation and for Cardiovascular Innovation, St. Paul's and Vancouver General Hospitals, Vancouver, British Columbia, Canada; Division of Cardiology, University of British Columbia & St. Paul's Hospital, Vancouver, British Columbia, Canada
| | - Ming-Yu A Chuang
- Centres for Heart Valve Innovation and for Cardiovascular Innovation, St. Paul's and Vancouver General Hospitals, Vancouver, British Columbia, Canada; Division of Cardiology, University of British Columbia & St. Paul's Hospital, Vancouver, British Columbia, Canada
| | - Jonathon A Leipsic
- Centres for Heart Valve Innovation and for Cardiovascular Innovation, St. Paul's and Vancouver General Hospitals, Vancouver, British Columbia, Canada; Division of Cardiology, University of British Columbia & St. Paul's Hospital, Vancouver, British Columbia, Canada; Cardiovascular Translational Laboratory, Centre for Heart Lung Innovation, University of British Columbia & St. Paul's Hospital, Vancouver, British Columbia, Canada; Department of Radiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Georgios Tzimas
- Department of Radiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Youcef Lounes
- Acute Care Surgery and Trauma, Division of General Surgery, Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - David Meier
- Centres for Heart Valve Innovation and for Cardiovascular Innovation, St. Paul's and Vancouver General Hospitals, Vancouver, British Columbia, Canada; Division of Cardiology, University of British Columbia & St. Paul's Hospital, Vancouver, British Columbia, Canada; Cardiovascular Translational Laboratory, Centre for Heart Lung Innovation, University of British Columbia & St. Paul's Hospital, Vancouver, British Columbia, Canada
| | - Janarthanan Sathananthan
- Centres for Heart Valve Innovation and for Cardiovascular Innovation, St. Paul's and Vancouver General Hospitals, Vancouver, British Columbia, Canada; Division of Cardiology, University of British Columbia & St. Paul's Hospital, Vancouver, British Columbia, Canada; Cardiovascular Translational Laboratory, Centre for Heart Lung Innovation, University of British Columbia & St. Paul's Hospital, Vancouver, British Columbia, Canada
| | - David A Wood
- Centres for Heart Valve Innovation and for Cardiovascular Innovation, St. Paul's and Vancouver General Hospitals, Vancouver, British Columbia, Canada; Division of Cardiology, University of British Columbia & St. Paul's Hospital, Vancouver, British Columbia, Canada; Cardiovascular Translational Laboratory, Centre for Heart Lung Innovation, University of British Columbia & St. Paul's Hospital, Vancouver, British Columbia, Canada
| | - John G Webb
- Centres for Heart Valve Innovation and for Cardiovascular Innovation, St. Paul's and Vancouver General Hospitals, Vancouver, British Columbia, Canada; Division of Cardiology, University of British Columbia & St. Paul's Hospital, Vancouver, British Columbia, Canada; Cardiovascular Translational Laboratory, Centre for Heart Lung Innovation, University of British Columbia & St. Paul's Hospital, Vancouver, British Columbia, Canada.
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Barthélémy O, Redheuil A, Collet JP. Cusp-Overlapping Projections in TAVR: Where the Left Meets the Right. JACC Cardiovasc Interv 2022; 15:162-164. [PMID: 35057986 DOI: 10.1016/j.jcin.2021.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 12/07/2021] [Indexed: 10/19/2022]
Affiliation(s)
- Olivier Barthélémy
- Sorbonne Université, ACTION Study Group, INSERM UMRS_1166 and 1146 Institut de Cardiologie, Pitié-Salpêtrière University Hospital (Assistance Publique-Hôpitaux de Paris), Paris, France.
| | - Alban Redheuil
- Sorbonne Université, ACTION Study Group, INSERM UMRS_1166 and 1146 Institut de Cardiologie, Pitié-Salpêtrière University Hospital (Assistance Publique-Hôpitaux de Paris), Paris, France
| | - Jean-Philippe Collet
- Sorbonne Université, ACTION Study Group, INSERM UMRS_1166 and 1146 Institut de Cardiologie, Pitié-Salpêtrière University Hospital (Assistance Publique-Hôpitaux de Paris), Paris, France
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