Impact of Cusp-Overlap View for TAVR with Self-Expandable Valves on 30-Day Conduction Disturbances

Mendiz, Oscar; Noč, Marko; Fava, Carlos; Jaikel, Luis Abel Gutiérrez; Sztejfman, Matías; Pleskovič, Aleš; Gamboa, Paul; Valdivieso, León; Gada, Hemal; Tang, Gilbert H.L.

doi:10.1155/2021/9991528

Cited by 57 publications

(32 citation statements)

References 21 publications

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“…The in-hospital mortality of 3.8% was in line with that of other local centers [13]. The reported in-hospital mortality from German registries is inversely related to the hospital case volume as reported by Bestehorn et al [15] who reported an average in-hospital mortality of 5.6 ±5.0% (range: 0-16.7%) in the lowest volume group of hospitals performing <50 transfemoral (TF)-TAVI annually, compared to 2.4 ±1.0% (range: 0.5-3.7%) in the highest volume hospitals with ≥200 TF-TAVI procedures per year. Vascular complications were seen in 15.4% of the patients, and the majority of them were minor.…”

Section: Discussionsupporting

confidence: 83%

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Self-Expandable Transcatheter Aortic Valve Implantation Outcomes: Findings From the Western Region of Saudi Arabia

Albugami¹,

Al-Husayni²,

Alfouti³

et al. 2021

Cureus

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Background and objectiveThe prevalence of aortic stenosis in Saudi Arabia is expected to increase owing to the rise in the life expectancy of the population. Such increase is expected to be met with higher demand for interventions including transcatheter aortic valve implantation (TAVI). In this study, we aimed to identify the outcomes of this procedure among the population of the Western region of Saudi Arabia. MethodsThis was a retrospective observational study involving patients who underwent TAVI at the King Faisal Cardiac Center (KFCC), Jeddah, Saudi Arabia from June 2018 to January 2020. All patients who had undergone TAVI were included, and patients who were lost to follow-up for more than 90 days were excluded. The collected data included sociodemographic characteristics, peri-procedural assessment, and outcomes within 90 days. ResultsThe study included a total of 52 patients. There were 28 males (53.8%) and 24 females (46.2%). The mean age of the cohort was 78 years. Type two diabetes mellitus was present in 67.3%, and hypertension and dyslipidemia were seen in 80.8% of patients. Coronary diseases were seen in 55.8%. The majority had prior percutaneous coronary intervention (PCI) (53.8%) and 3.8% had coronary artery bypass grafting (CABG). Twenty patients (38.5%) had heart failure. Atrial fibrillation was encountered in 13 patients (25%). Chronic kidney disease was described in nine (17.3%) patients, and four (7.7%) were on regular hemodialysis. The median Society of Thoracic Surgery (STS) risk score was 2.4 (IQR: 1.97-5). High STS scores (>8) were only seen in 9% of the patients. The success rate was 98%, and the in-hospital mortality rate was 3.8%. Vascular complications were seen in eight patients (15.4%), and the majority of them were minor. One patient (1.9%) had a major vascular complication. There was a tendency toward high blood transfusions (19.2%). Clinically manifest stroke was seen in three patients (5.8%). Eight patients (15.4%) had post-procedure complete heart block (CHB). Endocarditis was seen in two patients (3.8%). Thirty-day cardiac readmission was observed in 17.3% of patients, and acute kidney injury was seen in eight patients (15.4%). Mild aortic regurgitation was seen in 51.9% of the patients, but moderate or severe aortic insufficiency (AI) was not encountered. ConclusionTransfemoral TAVI using a self-expandable valve is a safe and feasible procedure at KFCC, an intermediatesized center. Our data is comparable to local and international centers of similar size. Program sustainability depends on the development of robust referral networks and implementing regulatory quality and patient safety standards.

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Section: Discussionsupporting

confidence: 83%

“…CHB during or post-procedure was encountered in 15.4% of the patients. Following the implementation of cusp overlap views [15] during deployment, in addition to enhancing experience, the rate of CHB in the latter 18 cases came down to zero.…”

Section: Discussionmentioning

confidence: 99%

Self-Expandable Transcatheter Aortic Valve Implantation Outcomes: Findings From the Western Region of Saudi Arabia

Albugami¹,

Al-Husayni²,

Alfouti³

et al. 2021

Cureus

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“…In this context two recent studies analyzed the incidence of conductance disturbances in COP patients and reported lower rates of LBBB and PPI [ 11 , 21 ]. However, data on this topic are still limited while the clinical need to reduce the rate of PPI in these patients is high.…”

Section: Discussionmentioning

confidence: 99%

Transcatheter Aortic Valve Replacement with the Self-Expandable Core Valve Evolut Prosthesis Using the Cusp-Overlap vs. Tricusp-View

Doldi

Stolz

Escher

et al. 2022

JCM

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Despite the rapid increase in experience and technological improvement, the incidence of conduction disturbances in patients undergoing transcatheter aortic valve replacement (TAVR) with the self-expandable CoreValve Evolut valve remains high. Recently, a cusp-overlap view (COP) implantation technique has been proposed for TAVR with self-expandable valves offering an improved visualization during valve expansion compared to the three-cusp view (TCV). This study aims to systematically analyze procedural outcomes of TAVR patients treated with the CoreValve Evolut valve using a COP compared to TCV in a high-volume center. The primary endpoint was technical success according the 2021 VARC-3 criteria. A total of 122 consecutive patients (61 pts. TCV: April 2019 to November 2020; 61 pts. COP: December 2020 to October 2021) that underwent TAVR with the CoreValve Evolut prosthesis were included in this analysis. Although there was no difference in the primary endpoint technical success between TCV and COP patients (93.4% vs. 90.2%, OR 0.65, 95% CI 0.16, 2.4, p = 0.51), we observed a significantly lower risk for permanent pacemaker implantation (PPI) among COP patients (TCV: 27.9% vs. COP: 13.1%, OR 0.39, 95% CI 0.15, 0.97, p = 0.047). Implantation of the CoreValve Evolut prosthesis using the COP might help to reduce the rate of PPI following TAVR.

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“…At least two studies published so far succeeded in demonstrating the benefit of this technique. 49,50 Pascual et al 49 studied 226 patients consecutively: 113 patients were treated using the cuspoverlap technique compared with 113 patients treated using the classic technique. The former had significantly lower rates of pacemaker implantation compared with the latter (12.4% vs. 23%, p = .036), showing that the cusp-overlap technique produces fewer conduction disturbances.…”

Section: Cusp Overlapmentioning

confidence: 99%

Lifetime management of aortic valve disease: Aligning surgical and transcatheter armamentarium to set the tone for the present and the future

Sá

Ramlawi

Sicouri

et al. 2021

Journal of Cardiac Surgery

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Transcatheter aortic valve replacement (TAVR) has already received the green light for high‐, intermediate‐ and low‐risk profiles and is an alternative for all patients regardless of age. It is clear that there has been a push towards the use of TAVR in younger and younger patients (<65 years), which has never been formally tested in randomized controlled trials but seems inevitable as TAVR technology makes steady progress. Lifetime management as a concept will set the tone in the field of the structural heart. Some subjects in this scenario arise, including the importance of optimized prosthetic hemodynamics for lifetime care; surgical procedures in the aortic root; management of structural valve degeneration with valve‐in‐valve procedures (TAVR‐in‐surgical aortic valve replacement [SAVR] and TAVR‐in‐TAVR) and redo SAVR; commissural alignment and cusp overlap for TAVR; the rise in the number of surgical procedures for TAVR explantation; and the renewed interest in the Ross procedure. This article reviews all these issues which will become commonplace during heart team meetings and preoperative conversations with patients in the coming years.

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Impact of Cusp-Overlap View for TAVR with Self-Expandable Valves on 30-Day Conduction Disturbances

Cited by 57 publications

References 21 publications

Self-Expandable Transcatheter Aortic Valve Implantation Outcomes: Findings From the Western Region of Saudi Arabia

Self-Expandable Transcatheter Aortic Valve Implantation Outcomes: Findings From the Western Region of Saudi Arabia

Transcatheter Aortic Valve Replacement with the Self-Expandable Core Valve Evolut Prosthesis Using the Cusp-Overlap vs. Tricusp-View

Lifetime management of aortic valve disease: Aligning surgical and transcatheter armamentarium to set the tone for the present and the future

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