Clin Res Cardiol (2022). https://doi.org/10.1007/s00392-022-02002-5

Cusp Overlap technique for self-expanding transcatheter aortic valves
H. S. Wienemann1, M. Beyer2, O. Maier3, V. Mauri1, T. Zeus3, E. Kuhn4, A. Schäfer5, S. Bleiziffer6, N. Schofer7, V. Veulemans3, T. K. Rudolph8, S. Baldus1, M. Adam1
1Klinik für Kardiologie, Angiologie, Pneumologie und Internistische Intensivmedizin, Herzzentrum der Universität zu Köln, Köln; 2Herzchirurgie, Universitäres Herz- Und Gefäßzentrum Hamburg Eppendorf, Hamburg; 3Klinik für Kardiologie, Pneumologie und Angiologie, Universitätsklinikum Düsseldorf, Düsseldorf; 4Klinik und Poliklinik für Herz- und Thoraxchirurgie, Herzzentrum, Universitätsklinikum Köln, Köln; 5Klinik und Poliklinik für Herz- und Gefäßchirurgie, Universitäres Herz- und Gefäßzentrum Hamburg GmbH, Hamburg; 6Klinik für Thorax- und Kardiovaskularchirurgie, Herz- und Diabeteszentrum NRW, Bad Oeynhausen; 7Allgemeine und Interventionelle Kardiologie, Universitäres Herz- und Gefäßzentrum Hamburg GmbH, Hamburg; 8Allgemeine und Interventionelle Kardiologie/Angiologie, Herz- und Diabeteszentrum NRW, Bad Oeynhausen;

Background:

Severe aortic valve stenosis is a frequent disease in the aging population. Transcatheter aortic valve implantation (TAVI) has become a standard of care therapy for patients > 75 years old or at increased surgical risk. While user experience with TAVI grows, complication rate decreases. However, permanent pacemaker implantation (PPMI) might still represent a challenge for TAVI therapy, particularly with self-expanding (SE) devices.

The standard technique for TAVI implantation includes an angiographic coplanar depiction of the aortic root with alignment of the right cusp between the left and the noncoronary cusps. The novel “Cusp-Overlap” (COP) technique utilizes a couple of procedural improvements, including a coplanar implantation projection with an overlap of the right coronary cusp (RCC) and left coronary cusp (LCC). Thereby, implanters might achieve a higher implant with less LVOT interference. Subsequently, decreased pacemaker rates have been published for COT. The aim of this study was to examine permanent pacemaker implantation (PPI) rates when using COP implantation technique for self-expanding valve implantation in the first real-world German multi-center analysis.

Methods:
This observational study comprised 2103 patients from 4 German centers. 283 patients were excluded due to prior PPMI. The conventional approach was utilized in 1070 (59%) patients (CON group). In 749 (41%) patients, the Cusp-Overlap technique was used for implantation (COP group). Patients treated with Evolut R or Pro were included in this study

Results:

The median patient age was 82 (interquartile range, 78.9 – 85.0) years in the study population. 369 (49.3%) patients were female in the COP group, whereas 585 (54.7%) female patients were analyzed in the CON group.  The Society for Thoracic Surgeons score was 3.74 [2.64, 5.80] in CON vs. 3.66 [2.34, 5.42] in the COP group.

Conversion to conventional cardiac surgery was not significantly different between the groups with 2 cases (0.3%) in COP vs 0 cases (0.0%) in the CON group; p = 0.176. Freedom of vascular complication was equally distributed and not statistical different between the two groups (594 (79.6%) for COP vs 850 (79.7%) for CON; p= 1.00). Implantation of a second valve was reported in 7 (0.9%) patients in the COP group vs. 9 (0.8%) patients in the CON group with no statistically difference (p=1.00).

Most importantly, we could show a significant decrease in permanent pacemaker implantation at discharge with 174 (16.3%) patients in CON group vs 96 (12.8%) in the COP group (p=0.044).

Conclusion: In this first retrospective real-world and multi-center study across German high-volume centers, utilizing the cusp overlap technique leads to a significant reduction in PPI without increasing major adverse cardiac event rate, compared to the conventional implantation technique.


https://dgk.org/kongress_programme/jt2022/aP1861.html