Transcatheter Aortic Valve Replacement with the Self-Expandable Core Valve Evolut Prosthesis Using the Cusp-Overlap vs. Tricusp-View

Philipp Maximilian Doldi; Lukas Stolz; Felix Escher; Julius Steffen; Jonas Gmeiner; Daniel Roden; Marie Linnemann; Kornelia Löw; Simon Deseive; Thomas J Stocker; Martin Orban; Hans Theiss; Konstantinos Rizas; Adrian Curta; Sebastian Sadoni; Joscha Buech; Dominik Joskowiak; Sven Peterss; Christian Hagl; Steffen Massberg; Jörg Hausleiter; Daniel Braun

doi:10.3390/jcm11061561

Transcatheter Aortic Valve Replacement with the Self-Expandable Core Valve Evolut Prosthesis Using the Cusp-Overlap vs. Tricusp-View

J Clin Med. 2022 Mar 12;11(6):1561. doi: 10.3390/jcm11061561.

Authors

Philipp Maximilian Doldi^{1

2}, Lukas Stolz¹, Felix Escher³, Julius Steffen^{1

2}, Jonas Gmeiner¹, Daniel Roden¹, Marie Linnemann¹, Kornelia Löw¹, Simon Deseive¹, Thomas J Stocker^{1

2}, Martin Orban^{1

2}, Hans Theiss¹, Konstantinos Rizas^{1

2}, Adrian Curta³, Sebastian Sadoni⁴, Joscha Buech⁴, Dominik Joskowiak⁴, Sven Peterss⁴, Christian Hagl⁴, Steffen Massberg^{1

2}, Jörg Hausleiter^{1

2}, Daniel Braun^{1

2}

Affiliations

¹ Medizinische Klinik und Poliklinik I, Klinikum der Universität München, 81377 Munich, Germany.
² German Center for Cardiovascular Research (DZHK), Munich Heart Alliance, 80539 Munich, Germany.
³ Klinik und Poliklinik für Radiologie, Klinikum der Universität München, 81377 Munich, Germany.
⁴ Herzchirurgische Klinik und Poliklinik, Klinikum der Universität München, 81377 Munich, Germany.

Abstract

Despite the rapid increase in experience and technological improvement, the incidence of conduction disturbances in patients undergoing transcatheter aortic valve replacement (TAVR) with the self-expandable CoreValve Evolut valve remains high. Recently, a cusp-overlap view (COP) implantation technique has been proposed for TAVR with self-expandable valves offering an improved visualization during valve expansion compared to the three-cusp view (TCV). This study aims to systematically analyze procedural outcomes of TAVR patients treated with the CoreValve Evolut valve using a COP compared to TCV in a high-volume center. The primary endpoint was technical success according the 2021 VARC-3 criteria. A total of 122 consecutive patients (61 pts. TCV: April 2019 to November 2020; 61 pts. COP: December 2020 to October 2021) that underwent TAVR with the CoreValve Evolut prosthesis were included in this analysis. Although there was no difference in the primary endpoint technical success between TCV and COP patients (93.4% vs. 90.2%, OR 0.65, 95% CI 0.16, 2.4, p = 0.51), we observed a significantly lower risk for permanent pacemaker implantation (PPI) among COP patients (TCV: 27.9% vs. COP: 13.1%, OR 0.39, 95% CI 0.15, 0.97, p = 0.047). Implantation of the CoreValve Evolut prosthesis using the COP might help to reduce the rate of PPI following TAVR.

Keywords: TAVI; TAVR; aortic stenosis; conduction disturbance; cusp-overlap view; permanent pacemaker implantation; self-expandable valves; three-cusp view.