High transcatheter heart valve implantation reduces conduction disturbances after TAVR: JACC

The authors reported the following findings:

• The high implantation technique reduced the incidence of new conduction disturbances after TAVR for both THVs.
• In the Evolut R/PRO/PRO+ group, post-TAVR CT showed that the HIT group had a higher incidence of the interference of THV skirt (22.0% vs 9.1%) and a lower incidence of the interference of THV commissural posts (26.0% vs 42.7%) with access to 1 or both coronary ostia compared with the CIT group.
• These incidences were similar between the HIT and CIT groups in the SAPIEN 3 group (THV skirt: 0.9% vs 0.7%; THV commissural tabs: 15.7% vs 15.3%).
• In both THVs, CT-identified risk of sinus sequestration in TAVR-in-TAVR was significantly higher in the HIT group compared with the CIT group (Evolut R/PRO/PRO+ group: 64.0% vs 41.8%; SAPIEN 3 group: 17.6% vs 5.3%).

"The study's findings provide insight to help guide design optimization of future THV platforms and highlight the significance of considering coronary access and the need for redo TAVR," the researchers wrote. "Findings support tailoring implantation technique based on anatomical and clinical factors to facilitate lifetime management of aortic stenosis patients."

Reference:

The study "Impact of High Implantation of Transcatheter Aortic Valve on Subsequent Conduction Disturbances and Coronary Access" was published in JACC: Cardiovascular Interventions. DOI: https://www.jacc.org/doi/10.1016/j.jcin.2023.03.021