AUTHOR=Maier Oliver , Piayda Kerstin , Binnebößel Stephan , Berisha Nora , Afzal Shazia , Polzin Amin , Klein Kathrin , Westenfeld Ralf , Horn Patrick , Jung Christian , Kelm Malte , Veulemans Verena , Zeus Tobias 

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

JOURNAL=Frontiers in Cardiovascular Medicine

VOLUME=Volume 9 - 2022

YEAR=2022

URL=https://www.frontiersin.org/journals/cardiovascular-medicine/articles/10.3389/fcvm.2022.847568

DOI=10.3389/fcvm.2022.847568

ISSN=2297-055X

ABSTRACT=Background:
The 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.

Methods: 
From 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 thirty-day outcomes were compared after 1:1 propensity score matching, resulting in 150 patients in both cohorts.

Results: 
The 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*cm2; 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).

Conclusions: 
TAVR 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.