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

Kornelia Löw,Marie Linnemann,Daniel Roden,Adrian Curta,Simon Deseive,Julius Steffen,Thomas J Stocker,Joscha Buech,Lukas Stolz,Sebastian Sadoni,Jonas Gmeiner,Daniel Braun,Christian Hagl,Philipp M Doldi ,Steffen Maßberg ,Hans Theiß ,Felicitas Escher ,Martin Orban ,Konstantinos D Rizas ,Dominik Jóskowiak ,Sven Peterß ,Jörg Hausleiter

doi:10.3390/jcm11061561

Kornelia Löw, Marie Linnemann + Show 20 more

Open Access

https://doi.org/10.3390/jcm11061561

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Abstract

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.

Highlights

In patients with symptomatic severe aortic stenosis (AS), transcatheter aortic valve replacement (TAVR) is currently the treatment of choice in most patients with intermediate or high surgical risk [1,2] and is increasingly used in patients with lower surgical risk [3,4]
Patients treated with self-expandable valves and baseline conduction disturbances show a higher incidence of pacemaker implantation (PPI) after TAVR [7,9,10]
This study demonstrates that the self-expandable CoreValve Evolut prosthesis can be implanted using the cusp-overlap view (COP) and the three-cusp view (TCV) with comparable efficacy and safety

Summary

Introduction

In patients with symptomatic severe aortic stenosis (AS), transcatheter aortic valve replacement (TAVR) is currently the treatment of choice in most patients with intermediate or high surgical risk [1,2] and is increasingly used in patients with lower surgical risk [3,4]. The numbers of TAVR procedures performed each year are steadily rising [5]. A concomitant increase in experience as well as technical advances helped to significantly reduce procedural complications within the last years. The incidence of conduction disturbances including bradycardia, left bundle branch block (LBBB), right bundle branch block (RBBB), and high grade atrio-ventricular block (HAVB) remains high. Permanent pacemaker implantation (PPI) following TAVR with self-expandable valves is frequent and occurs in 17–40% of patients [6–8]. Patients treated with self-expandable valves and baseline conduction disturbances show a higher incidence of PPI after TAVR [7,9,10]. TAVR implantation depth is a critical procedural factor that determines the necessity of new pacemaker implantation [11]

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