Cusp overlap technique improves TAVR outcomes, new meta-analysis confirms
Using the cusp overlap technique during transcatheter aortic valve replacement (TAVR) with a self-expanding valve significantly reduces the risk of permanent pacemaker implantation (PPMI) and helps get patients home faster, according to a new meta-analysis published in The American Journal of Cardiology.[1]
“TAVR has become the preferred treatment for symptomatic aortic stenosis, yet conduction disturbances leading to PPMI remain a significant complication, particularly with self‐expanding valves,” wrote first author Mohammad Hazique, MD, a researcher with Nuvance Health/Vassar Brothers Medical Center, and colleagues. “The cusp overlap view (COV) technique has been introduced to achieve a higher, more controlled valve implantation compared to the conventional coplanar view (CPV).”
Hazique et al. explored data from 14 different single-center clinical trials, focusing on more than 5,000 TAVR patients who were treated from 2015 to 2023. Most patients received a self-expanding Evolut, Evolut PRO or Evolut PRO+ TAVR valve from Medtronic.
The trials included in this meta-analysis covered patients who underwent TAVR in the United States, Japan, Germany, Spain, Portugal, Canada, India and Turkey. These tended to be low- and intermediate-risk patients, the authors noted, and a majority were treated using transfemoral access.
Overall, out of 5,266 patients, 53.4% underwent TAVR with the COV and the remaining 46.6% underwent TAVR with the CPV. The study’s primary outcome, PPMI, was seen in 11.2% of patients from the COV group and 17.7% of patients from the CPV group. In addition, patients in the COV group were associated with shorter hospital stays—the standardized mean difference was –0.56—and a slightly lower mean transvalvular gradient.
“This enhanced visualization offered by the COV allows for precise identification of the nadir of the aortic annulus and the membranous septum, reducing parallax and foreshortening,” the authors wrote. “This optimal positioning reduces mechanical trauma to the conduction system, particularly the bundle of His, which in turn lowers the risk of conduction disturbances and the need for PPMI. These results not only have the potential to improve patient outcomes and reduce healthcare resource utilization but also set a benchmark for standardizing TAVR protocols in clinical practice.”
The team did highlight certain limitations with its research. These were all observational studies performed at a single facility, for example, and the authors were unable to determine if patients treated later may have received certain benefits due to improvements in TAVR technologies. Also, because so many patients received a self-expanding TAVR valve, this research may not be as relevant for patients receiving a balloon-expandable valve. (PPMI is rarely as much of an issue with balloon-expandable devices, the group emphasized.)
Click here to read the full analysis.
Michael has more than 18 years of experience as a professional writer and editor. He has written at length about cardiology, radiology, artificial intelligence and other key healthcare topics.