Hybrid Approach Using the Cusp-Overlap Technique for Transcatheter Aortic Valve Replacement With a Balloon-Expandable Valve.

BACKGROUND

The cusp-overlap (CO) technique has recently been advocated and is being increasingly adopted for self-expandable transcatheter heart valve (THV) implantation.

OBJECTIVES

The aim of this study was to evaluate the feasibility, implantation depth, and outcomes of the CO technique for the balloon-expandable SAPIEN 3 THV.

METHODS

The CO technique was used in consecutive patients undergoing balloon-expandable THV implantation at one center between April 2021 and March 2022. Optimal fluoroscopic angles were determined from preprocedural computed tomography and confirmed on predeployment angiography. The THV radiolucent line was positioned 2 to 4 mm below the noncoronary cusp in the CO view, and positioning was confirmed in the 3-cusp view. Postdeployment THV implantation depth was assessed in both views. One-month outcomes were assessed using Valve Academic Research Consortium 3 criteria.

RESULTS

Among 137 patients eligible for the CO technique, the CO view was not used because of unfavorable ergonomics in 27 patients (26.5%) and hemodynamic instability in 8 patients (7.8%). Among 102 patients, the mean age was 81.1 ± 6.6 years, the mean Society of Thoracic Surgeons score was 3.3% ± 2.2%, and 64.7% were men. The mean measured THV implantation depth was 3.0 ± 1.4 mm in the CO view and 2.5 ± 1.4 mm in the 3-cusp view. At 1-month follow-up, 1 patient (1.0%) had died, 1 (1.0%) had had a stroke, and 7 (6.8%) had undergone permanent pacemaker implantation.

CONCLUSIONS

The CO technique is feasible and safe and may facilitate more accurate balloon-expandable THV positioning, especially when deep implantation needs to be avoided. Further studies are required to explore potential reduction in atrioventricular conduction block, pacemakers, or paravalvular regurgitation.

Informations de copyright

Copyright © 2022 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

Déclaration de conflit d'intérêts

Funding Support and Author Disclosures Dr Akodad has received research funding from Medtronic, Biotronik, Villa M, and Federation Française de Cardiologie. Dr Blanke is a consultant to Edwards Lifesciences; and provides computed tomography core laboratory services for Edwards Lifesciences, Medtronic, Neovasc, Boston Scientific, and Abbott, for which no direct compensation is received. Dr Nestelberger has received research support from the Swiss National Science Foundation (grant P400PM_191037/1), the Swiss Heart Foundation (grant FF20079), the Prof Dr Max Cloëtta Foundation, Margarete und Walter Lichtenstein-Stiftung (grant 3MS1038), University Basel, and University Hospital Basel; and has received speaker honoraria and consulting honoraria from Siemens, Beckman Coulter, Bayer, Ortho Clinical Diagnostics and Orion Pharma, all outside the submitted work. Dr Chatfield is funded by the New Zealand Heart Foundation and John Ormiston Scholarship. Dr Chuang is funded by the Royal Australian College of Physicians Vincent Fairfax Research Entry Scholarship. Dr Leipsic holds institutional research core laboratory agreements with Medtronic, Edwards Lifesciences, Abbott, Boston Scientific, and Pi CARDIA. Dr Meier is supported by the Swiss National Science Foundation (grant P2LAP3_199561). Dr Tzimas is supported by Fondation Vaudoise de Cardiologie and the SICPA Foundation. Dr Sathananthan has received speaker fees from Edwards Lifesciences and NVT Medical; and is a consultant for Edwards Lifesciences, Boston Scientific, and Medtronic. Dr Wood is a consultant for and receives unrestricted grant support from Medtronic, Edwards Lifesciences, and Abbott Vascular. Dr Webb is a consultant for Edwards Lifesciences. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.