Double S-Curve Versus Cusp-Overlap Technique Defining the Optimal Fluoroscopic Projection for TAVR With a Self-Expanding Device

OBJECTIVES The purpose of this study was to assess the concordance between transcatheter aortic valve implantation angles generated by the "double S-curve" and "cusp-overlap" techniques. BACKGROUND The "double S-curve" and "cusp-overlap" methods aim to define optimal fluoroscopic projections for transcatheter aortic valve replacement (TAVR) with a self-expandable device. METHODS The study included 100 consecutive patients undergoing TAVR with self-expanding device planned by multidetector computed tomography. TAVR was performed using the double S-curve model, as a view in which both the aortic valve annulus and delivery catheter planes are displayed perpendicularly on fluoroscopy. Optimal projection according to the cusp-overlap technique was retrospectively generated by overlapping the right and left cups on the multidetector computed tomography annular plane. The angular difference between methods was assessed in spherical 3 dimensions and on the left and right anterior oblique (RAO) and cranial and caudal (CAU) axes. RESULTS The double S-curve and cusp-overlap methods provided views located in the same quadrant, mostly the RAO and CAU, in 92% of patients with a median 3-dimensional angular difference of 10.0 degrees (interquartile range: 5.5 degrees to 17.9 degrees). The 3-dimensional deviation between the average angulation obtained by each method was not statistically significant (1.49 degrees; p - 0.349). No significant differences in average coordinates were noted between the double S-curve and cuspoverlap methods (RAO: 14.7 +/- 15.2 vs. 12.9 +/- 12.5; p - 0.36; and CAU: 27.0 +/- 9.4 vs. 26.9 +/- 10.4; p - 0.90). TAVR using the double S-curve was associated with 98% device success, low complication rate, and absence of moderate-to-severe paravalvular leak. CONCLUSIONS The double S-curve and cusp-overlap methods provide comparable TAVR projections, mostly RAO and CAU. TAVR using the double S-curve model is associated with a high rate of device success and low rate of procedural complications. (c) 2021 Published by Elsevier on behalf of the American College of Cardiology Foundation.