Real-world experience with the cusp-overlap deployment technique in transcatheter aortic valve replacement: A propensity-matched analysis

被引：12

作者：

Maier, Oliver ^{[1
]}

Piayda, Kerstin ^{[2
]}

Binneboessel, Stephan ^{[1
]}

Berisha, Nora ^{[1
]}

Afzal, Shazia ^{[1
]}

Polzin, Amin ^{[1
]}

Klein, Kathrin ^{[1
]}

Westenfeld, Ralf ^{[1
]}

Horn, Patrick ^{[1
]}

Jung, Christian ^{[1
]}

Kelm, Malte ^{[1
,3
]}

Veulemans, Verena ^{[1
]}

Zeus, Tobias ^{[1
]}

机构：

[1] Heinrich Heine Univ, Med Fac, Dept Cardiol Pulmonol & Vasc Med, Dusseldorf, Germany

[2] CardioVasc Ctr CVC Frankfurt, Frankfurt, Germany

[3] Heinrich Heine Univ, Cardiovasc Res Inst Dusseldorf CARID, Med Fac, Dusseldorf, Germany

来源：

FRONTIERS IN CARDIOVASCULAR MEDICINE | 2022年 / 9卷

关键词：

aortic stenosis; TAVR; implantation depth; cusp-overlap; permanent pacemaker; PERMANENT PACEMAKER IMPLANTATION; PREDICTORS; GUIDELINES; OUTCOMES; ANATOMY; SOCIETY; IMPACT; TAVR;

D O I：

10.3389/fcvm.2022.847568

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

BackgroundThe implantation depth (ID) is a critical condition for optimal hemodynamic and clinical outcomes in transcatheter aortic valve replacement (TAVR). The recently recommended cusp-overlap technique (COT) offers optimized fluoroscopic projections facilitating a precise ID. This single-center observational study aimed to investigate short-term clinical performance, safety, and efficacy outcomes in patients undergoing TAVR with self-expandable prostheses and application of COT in a real-world setting. Materials and methodsFrom September 2020 to April 2021, a total of 170 patients underwent TAVR with self-expandable devices and the application of COT, while 589 patients were treated from January 2016 to August 2020 with a conventional three-cusp coplanar view approach. The final ID and 30-day outcomes were compared after 1:1 propensity score matching, resulting in 150 patients in both cohorts. ResultsThe mean ID was significantly reduced in the COT cohort (-4.2 +/- 2.7 vs. -4.9 +/- 2.3 mm; p = 0.007) with an improvement of ID symmetry of less than 2 mm difference below the annular plane (47.3 vs. 57.3%; p = 0.083). The rate of new permanent pacemaker implantation (PPI) following TAVR was effectively reduced (8.0 vs. 16.8%; p = 0.028). While the fluoroscopy time decreased (18.4 +/- 7.6 vs. 19.8 +/- 7.6 min; p = 0.023), the dose area product increased in the COT group (4951 +/- 3662 vs. 3875 +/- 2775 Gy x cm(2); p = 0.005). Patients implanted with COT had a shorter length of in-hospital stay (8.4 +/- 4.0 vs. 10.3 +/- 6.7 days; p = 0.007). ConclusionTranscatheter aortic valve replacement using the cusp-overlap deployment technique is associated with an optimized implantation depth, leading to fewer permanent conduction disturbances. However, our in-depth analysis showed for the first time an increase of radiation dose due to extreme angulations of the gantry to obtain the cusp-overlap view.

引用

页数：13

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