Erschienen in:Frontiers in Cardiovascular Medicine
Sprache:
Nicht zu entscheiden
DOI:
10.3389/fcvm.2022.847568
ISSN:
2297-055X
Entstehung:
Anmerkungen:
Beschreibung:
<jats:sec><jats:title>Background</jats:title><jats:p>The implantation depth (ID) is a critical condition for optimal hemodynamic and clinical outcomes in transcatheter aortic valve replacement (TAVR). The recently recommended cusp-overlap technique (COT) offers optimized fluoroscopic projections facilitating a precise ID. This single-center observational study aimed to investigate short-term clinical performance, safety, and efficacy outcomes in patients undergoing TAVR with self-expandable prostheses and application of COT in a real-world setting.</jats:p></jats:sec><jats:sec><jats:title>Materials and methods</jats:title><jats:p>From September 2020 to April 2021, a total of 170 patients underwent TAVR with self-expandable devices and the application of COT, while 589 patients were treated from January 2016 to August 2020 with a conventional three-cusp coplanar view approach. The final ID and 30-day outcomes were compared after 1:1 propensity score matching, resulting in 150 patients in both cohorts.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>The mean ID was significantly reduced in the COT cohort (−4.2 ± 2.7 vs. −4.9 ± 2.3 mm; <jats:italic>p</jats:italic> = 0.007) with an improvement of ID symmetry of less than 2 mm difference below the annular plane (47.3 vs. 57.3%; <jats:italic>p</jats:italic> = 0.083). The rate of new permanent pacemaker implantation (PPI) following TAVR was effectively reduced (8.0 vs. 16.8%; <jats:italic>p</jats:italic> = 0.028). While the fluoroscopy time decreased (18.4 ± 7.6 vs. 19.8 ± 7.6 min; <jats:italic>p</jats:italic> = 0.023), the dose area product increased in the COT group (4951 ± 3662 vs. 3875 ± 2775 Gy × cm<jats:sup>2</jats:sup>; <jats:italic>p</jats:italic> = 0.005). Patients implanted with COT had a shorter length of in-hospital stay (8.4 ± 4.0 vs. 10.3 ± 6.7 days; <jats:italic>p</jats:italic> = 0.007).</jats:p></jats:sec><jats:sec><jats:title>Conclusion</jats:title><jats:p>Transcatheter aortic valve replacement using the cusp-overlap deployment technique is associated with an optimized implantation depth, leading to fewer permanent conduction disturbances. However, our in-depth analysis showed for the first time an increase of radiation dose due to extreme angulations of the gantry to obtain the cusp-overlap view.</jats:p></jats:sec>