Comparison of cusp-overlap projection and standard three-cusp coplanar view during self-expanding transcatheter aortic valve replacement: A systematic review and meta-analysis

Abstract

ObjectivePermanent pacemaker implantation (PPI) is a common complication after transcatheter aortic valve replacement (TAVR). Recently, the cusp-overlap projection (COP) technique was thought to be a feasible method to reduce PPI risk. However, the evidence is still relatively scarce. Therefore, this meta-analysis was performed to compare COP and standard three-cusp coplanar (TCC) projection technique.MethodsPubMed and EMBASE databases were systematically searched for relevant literature published from the inception (EMBASE from 1974 and PubMed from 1966) to 16 April 2022, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. The primary outcome of interest was post-operative (including in-hospital and 30-day) PPI.ResultsTotal of 3,647 subjects from 11 studies were included in this meta-analysis. Of those, 1,453 underwent self-expanding TAVR using COP and 2,194 using TCC technique. In a pooled analysis, the cumulative PPI incidence was 9.3% [95% confidence interval (CI): 6.9–11.7%] and 18.9% (95% CI: 15.5–22.3%) in the COP group and TCC group, respectively. The application of the COP technique was associated with a significant PPI risk reduction (I2 = 40.3% and heterogeneity Chi-square p = 0.070, random-effects OR: 0.49, 95% CI: 0.36–0.66, p < 0.001). A higher implantation depth was achieved in the COP group compared with the TCC group [standardized mean difference (SMD) = −0.324, 95% CI: (−0.469, −0.180)]. There was no significant difference between the two groups in second valve implantation, prosthesis pop-out, fluoroscopic time, post-operative left bundle branch block, mortality, stroke, moderate/severe paravalvular leakage, mean gradient, and length of hospital stay. However, radiation doses were higher in the COP group [SMD = 0.394, 95% CI: (0.216, 0.572), p < 0.001].ConclusionIn self-expanding TAVR, the application of the cusp overlap projection technique was associated with a lower risk of PPI compared with the standard TCC technique.Systematic review registration[https://inplasy.com/inplasy-2022-4-0092/], identifier [INPLASY202240092].

Predictors for new-onset conduction block in patients with pure native aortic regurgitation after transcatheter aortic valve replacement with a new-generation self-expanding valve (VitaFlow Liberty™): a retrospective cohort study

“…Finally, the prosthesis comes in contact with the side of the left coronary cusp (LCC), completing the valve release. Therefore, deployment of self-expanding valves is usually asymmetric [ 36 ]. Moreover, in our study, a smaller aortic root angle was associated with improved coaxiality and better alignment between the valve stent device and the aortic root, i.e., with a smaller angle between the plane of the lower valve stent device edge and the annular plane.…”

Cusp-overlap view reduces conduction disturbances and permanent pacemaker implantation after transcatheter aortic valve replacement even with balloon-expandable and mechanically-expandable heart valves

“…To date, numerous risk factors for PPI after TAVR are well known, including amongst others LVOT calcification, preexisting conduction abnormalities like RBBB, left anterior hemiblock or first-degree atrioventricular block as well as the choice of valve prosthesis, degree of prothesis oversizing, short membranous septum length and depth of implantation of the new valve (12, 13,16,21,22,30). Besides the right prosthesis choice and oversizing ratio in some extent, especially the optimization of the ID represents a promising approach to reduce the risk of PPI after TAVR (23,31). Due to the location of the conduction system with its bundle of His and the left bundle branch just below the annulus plane, a higher valve ID in the LVOT can reduce the risk of interaction with the conduction tissue and consequently the PPI risk after TAVR (15,32,33).…”

“…Nowadays, several predictors associated with increased risk for post-procedural PPI are described in literature, however most of them are not modifiable (12,13,16,21,22). Optimization of the implantation depth (ID) by introducing the cusp-overlap projection (COP) technique might be a viable approach to lower the risk of interaction with the conduction system (23,24). In TAVR using a self-expanding Evolut series prosthesis, the novel COP technique led to a significant higher prosthesis release and was associated with a reduced risk of PPI (25)(26)(27).…”

Patient‐specific computer simulation of transcatheter aortic valve replacement in patients with previous mechanical mitral prosthesis: A case series

“…Fluoroscopy guidance was also useful to detect intraprocedural valve and access complications. THV deployment was performed with cusp‐overlap projection (COP) technique to evaluate a more accurate implantation depth 5 . Prosthesis implantation was performed during left intraventricular pacing.…”