Use of cusp-overlapping projection in TAVR reduces rate of permanent pacemaker implantation: JACC
Spain: A novel cusp-overlapping projection (COP) technique was shown to significantly reduce the rate of permanent pacemaker implantation (PPMI) in self-expanding (SE) transcatheter heart valve (THV) implantation versus the classical implantation technique, states a recent study. Also, both the techniques were found to have similar rates of complications.
"The findings imply that the COP implantation technique is a safe and feasible modification to the transcatheter aortic valve replacement (TAVR) protocol, " Isaac Pascual, Research Institute of the Principado de Asturias, Oviedo, Spain, and colleagues wrote in their study published in the journal JACC: Cardiovascular Interventions. "This is the first study to systematically evaluate this approach for SE THVs in different populations."
The COP technique was shown to have a potential benefit of an optimized implantation depth to reduce the PPMI rate. However, not many studies have compared clinical outcomes with those achieved using the standard technique.
Considering the above, Dr. Pascual and colleagues conducted the study with an aim to determine if modifying the classical implantation technique for SE transcatheter aortic valve replacement to a novel COP technique leads to a higher implantation depth (ID) and a subsequent reduction in the rates of PPMI.
The study included 444 consequent patients beginning in February 2015. Because of the observational nature of the study propensity score matching was used to control baseline characteristics. A total of 161 pairs of patients were analyzed. Three methods were used to measure ID (noncoronary cusp [NCC] to the THV, mean of the NCC and the left coronary cusp [LCC] to the THV, and the deepest edge from the LCC and the NCC to the THV).
Based on the study, the authors gave the following findings:
- ID was significantly higher in COP cases when measuring from the NCC (4.2 mm vs 5.3 mm) and the mean from the NCC and the LCC (5.3 mm vs 5.9 mm), but not from the deepest edge.
- The PPMI rate was lower in the COP group: 19 (11.8%) vs 35 (21.7%) (relative risk: 0.54).
The authors conclude, "COP technique significantly reduces PPMI in SE THV implantation compared with the classical implantation technique, with similar rates of complications."
Reference:
The study titled, "Permanent Pacemaker Reduction Using Cusp-Overlapping Projection in TAVR: A Propensity Score Analysis," was published in the journal JACC: Cardiovascular Interventions.
