Cusp-overlap technique during TAVI using the self-expanding Portico FlexNav system

Introduction and objectives: The cusp overlap technique (COT) has been proposed to reduce conduction disturbances (CD) after transcatheter aortic valve implantation (TAVI) with self-expanding supra-annular devices, but there are scarce data on COT with intra-annular valves. The aim of this study was to determine whether the use of the COT during Portico implantation results in higher valve implantation and lower rates of CD. Methods: We included 85 patients undergoing TAVI with the Portico FlexNav system: 43 retrospective patients using the standard 3-cusp view and 42 prospective patients with the COT. Primary endpoints were implantation depth and new-onset CD (composite outcome of new-onset left bundle branch block and new permanent pacemaker implantation). Results: COT resulted in a higher implantation depth (noncoronary cusp: 4.9 +/- 3.9 vs 7.4 +/- 3.0; P =.005) and lower new-onset CD (31.0% vs 58.1%; P =.012), with a tendency toward a lower need for permanent pacemaker implantation (14.3% vs 30.2%, P =.078; 7.7% vs 31.0%; P =.011 in patients without pre-existing right bundle branch block). Transvalvular aortic gradients were slightly lower with COT (8.7 +/- 3.7 vs 11.0 +/- 6.1; P =.044). There were no differences in technical success or major procedure-related complications. On multivariate analysis, COT use was associated with a lower risk of new-onset CD. Conclusions: Use of the COT during Portico implantation is feasible and facilitates a higher valve implant, which in turn may help to reduce rates of new-onset CD. (C) 2023 Published by Elsevier Espana, S.L.U. on behalf of Sociedad Espanaola de Cardiologia.