Cusp overlap versus standard three-cusp technique for self-expanding Evolut transcatheter aortic valves
Reducing rates of permanent pacemaker implantation (PPI) after transcatheter aortic valve implantation (TAVI) is important for achieving the best procedural outcomes. The cusp overlap technique (COT) implements procedural steps including an overlap angulation of the right and left coronary cusp to m...
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| Veröffentlicht in: | EuroIntervention 2023-06, Vol.19 (2), p.e176-e187 |
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| creator | Wienemann, Hendrik Maier, Oliver Beyer, Martin Portratz, Max Tanaka, Tetsu Mauri, Victor Ernst, Angela Waldschmidt, Lara Kuhn, Elmar Bleiziffer, Sabine Wilde, Nihal Schaefer, Andreas Zeus, Tobias Baldus, Stephan Zimmer, Sebastian Veulemans, Verena Rudolph, Tanja Katharina Adam, Matti |
| description | Reducing rates of permanent pacemaker implantation (PPI) after transcatheter aortic valve implantation (TAVI) is important for achieving the best procedural outcomes. The cusp overlap technique (COT) implements procedural steps including an overlap angulation of the right and left coronary cusp to mitigate this complication.
We investigated the incidence of PPI and complication rates following the COT compared to the standard three-cusp implantation technique (3CT) in an all-comers cohort.
A total of 2,209 patients underwent TAVI with the self-expanding Evolut platform from January 2016 to April 2022 at five sites. Baseline, procedural and in-hospital outcome characteristics were compared for both techniques before and after one-to-one propensity score matching.
A total of 1,151 patients were implanted using the 3CT and 1,058 using the COT. At discharge, the rates of PPI (17.0 vs 12.3%; p=0.002) and moderate/severe paravalvular regurgitation (4.6% vs 2.4%; p=0.006) were significantly reduced with the COT compared with 3CT within the unmatched cohort. Overall procedural success and complication rates were similar; major bleeding was less common in the COT group (7.0% vs 4.6%; p=0.020). These results remained consistent after propensity score matching. In multivariable logistic regression analysis, right bundle branch block (odds ratio [OR] 7.19, 95% confidence interval [CI]: 5.18-10.0; p |
| doi_str_mv | 10.4244/EIJ-D-22-01030 |
| format | Article |
| fullrecord | <record><control><sourceid>pubmed_cross</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_10240731</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>37013922</sourcerecordid><originalsourceid>FETCH-LOGICAL-c351t-2e4582042b92392251ebf209c3e26878edc309a33b743fa3db50e47b7c35440c3</originalsourceid><addsrcrecordid>eNpVkM1OwzAQhC0EoqVw5Yj8Ai7-S5OcEGoLFFXiAmfLcTZNUJoE24ng7XEpVOW0K-3M7OhD6JrRqeRS3i5Xz2RBOCeUUUFP0Jils5TMOBOnR_sIXTj3TqlMKIvP0UjElImU8zHazHvX4XYAW-sOh-F6h53XTa5tjn1pAYjZSTyYsqk-esBFa7GDuiDw2QVd1Wzwcmjr3mNvdeOM9iV4sFi31lcGD7oewF2is0LXDq5-5wS9PSxf509k_fK4mt-viRER84SDjBJOJc9SvisYMcgKTlMjgM-SOIHcCJpqIbJYikKLPIsoyDiLg11KasQE3e1zuz7bBjU0oVStOltttf1Sra7U_0tTlWrTDopRLmksWEiY7hOMbZ2zUBzMjKodcxWYq4XiXP0wD4ab45cH-R9k8Q3eIX-e</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype></control><display><type>article</type><title>Cusp overlap versus standard three-cusp technique for self-expanding Evolut transcatheter aortic valves</title><source>MEDLINE</source><source>PubMed Central</source><creator>Wienemann, Hendrik ; Maier, Oliver ; Beyer, Martin ; Portratz, Max ; Tanaka, Tetsu ; Mauri, Victor ; Ernst, Angela ; Waldschmidt, Lara ; Kuhn, Elmar ; Bleiziffer, Sabine ; Wilde, Nihal ; Schaefer, Andreas ; Zeus, Tobias ; Baldus, Stephan ; Zimmer, Sebastian ; Veulemans, Verena ; Rudolph, Tanja Katharina ; Adam, Matti</creator><creatorcontrib>Wienemann, Hendrik ; Maier, Oliver ; Beyer, Martin ; Portratz, Max ; Tanaka, Tetsu ; Mauri, Victor ; Ernst, Angela ; Waldschmidt, Lara ; Kuhn, Elmar ; Bleiziffer, Sabine ; Wilde, Nihal ; Schaefer, Andreas ; Zeus, Tobias ; Baldus, Stephan ; Zimmer, Sebastian ; Veulemans, Verena ; Rudolph, Tanja Katharina ; Adam, Matti</creatorcontrib><description>Reducing rates of permanent pacemaker implantation (PPI) after transcatheter aortic valve implantation (TAVI) is important for achieving the best procedural outcomes. The cusp overlap technique (COT) implements procedural steps including an overlap angulation of the right and left coronary cusp to mitigate this complication.
We investigated the incidence of PPI and complication rates following the COT compared to the standard three-cusp implantation technique (3CT) in an all-comers cohort.
A total of 2,209 patients underwent TAVI with the self-expanding Evolut platform from January 2016 to April 2022 at five sites. Baseline, procedural and in-hospital outcome characteristics were compared for both techniques before and after one-to-one propensity score matching.
A total of 1,151 patients were implanted using the 3CT and 1,058 using the COT. At discharge, the rates of PPI (17.0 vs 12.3%; p=0.002) and moderate/severe paravalvular regurgitation (4.6% vs 2.4%; p=0.006) were significantly reduced with the COT compared with 3CT within the unmatched cohort. Overall procedural success and complication rates were similar; major bleeding was less common in the COT group (7.0% vs 4.6%; p=0.020). These results remained consistent after propensity score matching. In multivariable logistic regression analysis, right bundle branch block (odds ratio [OR] 7.19, 95% confidence interval [CI]: 5.18-10.0; p<0.001) and diabetes mellitus (OR 1.38, 95% CI: 1.05-1.80; p=0.021) emerged as predictors of PPI, whereas the COT (OR 0.63, 95% CI: 0.49-0.82; p<0.001) was protective.
The introduction of the COT was associated with a significant and relevant reduction of PPI and paravalvular regurgitation rates without an increase in complication rates.</description><identifier>ISSN: 1969-6213</identifier><identifier>ISSN: 1774-024X</identifier><identifier>EISSN: 1969-6213</identifier><identifier>DOI: 10.4244/EIJ-D-22-01030</identifier><identifier>PMID: 37013922</identifier><language>eng</language><publisher>France: Europa Edition</publisher><subject>Aortic Valve - surgery ; Aortic Valve Stenosis ; Aortic Valve Stenosis - surgery ; Clinical Research ; Heart Valve Prosthesis ; Humans ; Pacemaker, Artificial ; Permanent Pacemaker Implantation ; Postoperative Complications - epidemiology ; Prosthesis Design ; Risk Factors ; Transcatheter Aortic Valve Implantation ; Transcatheter Aortic Valve Replacement - adverse effects ; Transcatheter Aortic Valve Replacement - methods ; Treatment Outcome</subject><ispartof>EuroIntervention, 2023-06, Vol.19 (2), p.e176-e187</ispartof><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c351t-2e4582042b92392251ebf209c3e26878edc309a33b743fa3db50e47b7c35440c3</citedby><cites>FETCH-LOGICAL-c351t-2e4582042b92392251ebf209c3e26878edc309a33b743fa3db50e47b7c35440c3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC10240731/pdf/$$EPDF$$P50$$Gpubmedcentral$$H</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC10240731/$$EHTML$$P50$$Gpubmedcentral$$H</linktohtml><link.rule.ids>230,315,728,781,785,886,27929,27930,53796,53798</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/37013922$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Wienemann, Hendrik</creatorcontrib><creatorcontrib>Maier, Oliver</creatorcontrib><creatorcontrib>Beyer, Martin</creatorcontrib><creatorcontrib>Portratz, Max</creatorcontrib><creatorcontrib>Tanaka, Tetsu</creatorcontrib><creatorcontrib>Mauri, Victor</creatorcontrib><creatorcontrib>Ernst, Angela</creatorcontrib><creatorcontrib>Waldschmidt, Lara</creatorcontrib><creatorcontrib>Kuhn, Elmar</creatorcontrib><creatorcontrib>Bleiziffer, Sabine</creatorcontrib><creatorcontrib>Wilde, Nihal</creatorcontrib><creatorcontrib>Schaefer, Andreas</creatorcontrib><creatorcontrib>Zeus, Tobias</creatorcontrib><creatorcontrib>Baldus, Stephan</creatorcontrib><creatorcontrib>Zimmer, Sebastian</creatorcontrib><creatorcontrib>Veulemans, Verena</creatorcontrib><creatorcontrib>Rudolph, Tanja Katharina</creatorcontrib><creatorcontrib>Adam, Matti</creatorcontrib><title>Cusp overlap versus standard three-cusp technique for self-expanding Evolut transcatheter aortic valves</title><title>EuroIntervention</title><addtitle>EuroIntervention</addtitle><description>Reducing rates of permanent pacemaker implantation (PPI) after transcatheter aortic valve implantation (TAVI) is important for achieving the best procedural outcomes. The cusp overlap technique (COT) implements procedural steps including an overlap angulation of the right and left coronary cusp to mitigate this complication.
We investigated the incidence of PPI and complication rates following the COT compared to the standard three-cusp implantation technique (3CT) in an all-comers cohort.
A total of 2,209 patients underwent TAVI with the self-expanding Evolut platform from January 2016 to April 2022 at five sites. Baseline, procedural and in-hospital outcome characteristics were compared for both techniques before and after one-to-one propensity score matching.
A total of 1,151 patients were implanted using the 3CT and 1,058 using the COT. At discharge, the rates of PPI (17.0 vs 12.3%; p=0.002) and moderate/severe paravalvular regurgitation (4.6% vs 2.4%; p=0.006) were significantly reduced with the COT compared with 3CT within the unmatched cohort. Overall procedural success and complication rates were similar; major bleeding was less common in the COT group (7.0% vs 4.6%; p=0.020). These results remained consistent after propensity score matching. In multivariable logistic regression analysis, right bundle branch block (odds ratio [OR] 7.19, 95% confidence interval [CI]: 5.18-10.0; p<0.001) and diabetes mellitus (OR 1.38, 95% CI: 1.05-1.80; p=0.021) emerged as predictors of PPI, whereas the COT (OR 0.63, 95% CI: 0.49-0.82; p<0.001) was protective.
The introduction of the COT was associated with a significant and relevant reduction of PPI and paravalvular regurgitation rates without an increase in complication rates.</description><subject>Aortic Valve - surgery</subject><subject>Aortic Valve Stenosis</subject><subject>Aortic Valve Stenosis - surgery</subject><subject>Clinical Research</subject><subject>Heart Valve Prosthesis</subject><subject>Humans</subject><subject>Pacemaker, Artificial</subject><subject>Permanent Pacemaker Implantation</subject><subject>Postoperative Complications - epidemiology</subject><subject>Prosthesis Design</subject><subject>Risk Factors</subject><subject>Transcatheter Aortic Valve Implantation</subject><subject>Transcatheter Aortic Valve Replacement - adverse effects</subject><subject>Transcatheter Aortic Valve Replacement - methods</subject><subject>Treatment Outcome</subject><issn>1969-6213</issn><issn>1774-024X</issn><issn>1969-6213</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2023</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpVkM1OwzAQhC0EoqVw5Yj8Ai7-S5OcEGoLFFXiAmfLcTZNUJoE24ng7XEpVOW0K-3M7OhD6JrRqeRS3i5Xz2RBOCeUUUFP0Jils5TMOBOnR_sIXTj3TqlMKIvP0UjElImU8zHazHvX4XYAW-sOh-F6h53XTa5tjn1pAYjZSTyYsqk-esBFa7GDuiDw2QVd1Wzwcmjr3mNvdeOM9iV4sFi31lcGD7oewF2is0LXDq5-5wS9PSxf509k_fK4mt-viRER84SDjBJOJc9SvisYMcgKTlMjgM-SOIHcCJpqIbJYikKLPIsoyDiLg11KasQE3e1zuz7bBjU0oVStOltttf1Sra7U_0tTlWrTDopRLmksWEiY7hOMbZ2zUBzMjKodcxWYq4XiXP0wD4ab45cH-R9k8Q3eIX-e</recordid><startdate>20230605</startdate><enddate>20230605</enddate><creator>Wienemann, Hendrik</creator><creator>Maier, Oliver</creator><creator>Beyer, Martin</creator><creator>Portratz, Max</creator><creator>Tanaka, Tetsu</creator><creator>Mauri, Victor</creator><creator>Ernst, Angela</creator><creator>Waldschmidt, Lara</creator><creator>Kuhn, Elmar</creator><creator>Bleiziffer, Sabine</creator><creator>Wilde, Nihal</creator><creator>Schaefer, Andreas</creator><creator>Zeus, Tobias</creator><creator>Baldus, Stephan</creator><creator>Zimmer, Sebastian</creator><creator>Veulemans, Verena</creator><creator>Rudolph, Tanja Katharina</creator><creator>Adam, Matti</creator><general>Europa Edition</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>5PM</scope></search><sort><creationdate>20230605</creationdate><title>Cusp overlap versus standard three-cusp technique for self-expanding Evolut transcatheter aortic valves</title><author>Wienemann, Hendrik ; Maier, Oliver ; Beyer, Martin ; Portratz, Max ; Tanaka, Tetsu ; Mauri, Victor ; Ernst, Angela ; Waldschmidt, Lara ; Kuhn, Elmar ; Bleiziffer, Sabine ; Wilde, Nihal ; Schaefer, Andreas ; Zeus, Tobias ; Baldus, Stephan ; Zimmer, Sebastian ; Veulemans, Verena ; Rudolph, Tanja Katharina ; Adam, Matti</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c351t-2e4582042b92392251ebf209c3e26878edc309a33b743fa3db50e47b7c35440c3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2023</creationdate><topic>Aortic Valve - surgery</topic><topic>Aortic Valve Stenosis</topic><topic>Aortic Valve Stenosis - surgery</topic><topic>Clinical Research</topic><topic>Heart Valve Prosthesis</topic><topic>Humans</topic><topic>Pacemaker, Artificial</topic><topic>Permanent Pacemaker Implantation</topic><topic>Postoperative Complications - epidemiology</topic><topic>Prosthesis Design</topic><topic>Risk Factors</topic><topic>Transcatheter Aortic Valve Implantation</topic><topic>Transcatheter Aortic Valve Replacement - adverse effects</topic><topic>Transcatheter Aortic Valve Replacement - methods</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Wienemann, Hendrik</creatorcontrib><creatorcontrib>Maier, Oliver</creatorcontrib><creatorcontrib>Beyer, Martin</creatorcontrib><creatorcontrib>Portratz, Max</creatorcontrib><creatorcontrib>Tanaka, Tetsu</creatorcontrib><creatorcontrib>Mauri, Victor</creatorcontrib><creatorcontrib>Ernst, Angela</creatorcontrib><creatorcontrib>Waldschmidt, Lara</creatorcontrib><creatorcontrib>Kuhn, Elmar</creatorcontrib><creatorcontrib>Bleiziffer, Sabine</creatorcontrib><creatorcontrib>Wilde, Nihal</creatorcontrib><creatorcontrib>Schaefer, Andreas</creatorcontrib><creatorcontrib>Zeus, Tobias</creatorcontrib><creatorcontrib>Baldus, Stephan</creatorcontrib><creatorcontrib>Zimmer, Sebastian</creatorcontrib><creatorcontrib>Veulemans, Verena</creatorcontrib><creatorcontrib>Rudolph, Tanja Katharina</creatorcontrib><creatorcontrib>Adam, Matti</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>EuroIntervention</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Wienemann, Hendrik</au><au>Maier, Oliver</au><au>Beyer, Martin</au><au>Portratz, Max</au><au>Tanaka, Tetsu</au><au>Mauri, Victor</au><au>Ernst, Angela</au><au>Waldschmidt, Lara</au><au>Kuhn, Elmar</au><au>Bleiziffer, Sabine</au><au>Wilde, Nihal</au><au>Schaefer, Andreas</au><au>Zeus, Tobias</au><au>Baldus, Stephan</au><au>Zimmer, Sebastian</au><au>Veulemans, Verena</au><au>Rudolph, Tanja Katharina</au><au>Adam, Matti</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Cusp overlap versus standard three-cusp technique for self-expanding Evolut transcatheter aortic valves</atitle><jtitle>EuroIntervention</jtitle><addtitle>EuroIntervention</addtitle><date>2023-06-05</date><risdate>2023</risdate><volume>19</volume><issue>2</issue><spage>e176</spage><epage>e187</epage><pages>e176-e187</pages><issn>1969-6213</issn><issn>1774-024X</issn><eissn>1969-6213</eissn><abstract>Reducing rates of permanent pacemaker implantation (PPI) after transcatheter aortic valve implantation (TAVI) is important for achieving the best procedural outcomes. The cusp overlap technique (COT) implements procedural steps including an overlap angulation of the right and left coronary cusp to mitigate this complication.
We investigated the incidence of PPI and complication rates following the COT compared to the standard three-cusp implantation technique (3CT) in an all-comers cohort.
A total of 2,209 patients underwent TAVI with the self-expanding Evolut platform from January 2016 to April 2022 at five sites. Baseline, procedural and in-hospital outcome characteristics were compared for both techniques before and after one-to-one propensity score matching.
A total of 1,151 patients were implanted using the 3CT and 1,058 using the COT. At discharge, the rates of PPI (17.0 vs 12.3%; p=0.002) and moderate/severe paravalvular regurgitation (4.6% vs 2.4%; p=0.006) were significantly reduced with the COT compared with 3CT within the unmatched cohort. Overall procedural success and complication rates were similar; major bleeding was less common in the COT group (7.0% vs 4.6%; p=0.020). These results remained consistent after propensity score matching. In multivariable logistic regression analysis, right bundle branch block (odds ratio [OR] 7.19, 95% confidence interval [CI]: 5.18-10.0; p<0.001) and diabetes mellitus (OR 1.38, 95% CI: 1.05-1.80; p=0.021) emerged as predictors of PPI, whereas the COT (OR 0.63, 95% CI: 0.49-0.82; p<0.001) was protective.
The introduction of the COT was associated with a significant and relevant reduction of PPI and paravalvular regurgitation rates without an increase in complication rates.</abstract><cop>France</cop><pub>Europa Edition</pub><pmid>37013922</pmid><doi>10.4244/EIJ-D-22-01030</doi></addata></record> |
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| identifier | ISSN: 1969-6213 |
| ispartof | EuroIntervention, 2023-06, Vol.19 (2), p.e176-e187 |
| issn | 1969-6213 1774-024X 1969-6213 |
| language | eng |
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| subjects | Aortic Valve - surgery Aortic Valve Stenosis Aortic Valve Stenosis - surgery Clinical Research Heart Valve Prosthesis Humans Pacemaker, Artificial Permanent Pacemaker Implantation Postoperative Complications - epidemiology Prosthesis Design Risk Factors Transcatheter Aortic Valve Implantation Transcatheter Aortic Valve Replacement - adverse effects Transcatheter Aortic Valve Replacement - methods Treatment Outcome |
| title | Cusp overlap versus standard three-cusp technique for self-expanding Evolut transcatheter aortic valves |
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