Impact of different guidewires on the implantation depth using the largest self-expandable TAVI device

Verena Veulemans; Nihal Wilde; Hendrik Wienemann; Rik Adrichem; Thijmen W Hokken; Baravan Al-Kassou; Jasmin Shamekhi; Victor Mauri; Oliver Maier; Christian Jung; Patrick Horn; Matti Adam; Georg Nickenig; Stephan Baldus; Nicolas M Van Mieghem; Malte Kelm; Alexander Sedaghat; Tobias Zeus

doi:10.3389/fcvm.2022.1064916

Impact of different guidewires on the implantation depth using the largest self-expandable TAVI device

Front Cardiovasc Med. 2023 Jan 5:9:1064916. doi: 10.3389/fcvm.2022.1064916. eCollection 2022.

Authors

Verena Veulemans^{1

2}, Nihal Wilde³, Hendrik Wienemann⁴, Rik Adrichem⁵, Thijmen W Hokken⁵, Baravan Al-Kassou³, Jasmin Shamekhi³, Victor Mauri⁴, Oliver Maier¹, Christian Jung¹, Patrick Horn¹, Matti Adam⁴, Georg Nickenig³, Stephan Baldus⁴, Nicolas M Van Mieghem⁵, Malte Kelm^{1

2}, Alexander Sedaghat³, Tobias Zeus¹

Affiliations

¹ Department of Cardiology, Pulmonology, and Vascular Diseases, University Hospital Düsseldorf, Düsseldorf, Germany.
² Cardiovascular Research Institute, Düsseldorf, Germany.
³ Department of Medicine II, Heart Center, University Hospital Bonn, Bonn, Germany.
⁴ Department of Cardiology, Heart Center, University of Cologne, Cologne, Germany.
⁵ Department of Cardiology, Erasmus University Medical Center, Rotterdam, Netherlands.

Abstract

Background: The deployment process of the largest self-expandable device (STHV-34) during transcatheter aortic valve implantation (TAVI) might be challenging due to stabilization issues. Whether the use of different TAVI-guidewires impact the procedural success and outcome is not well-known. Therefore, we sought to evaluate the impact of non-Lunderquist (NLu) vs. the Lunderquist (Lu) guidewires during TAVI using the STHV-34 on the procedural and 30-day outcomes.

Methods: The primary study endpoint was defined as the final implantation depth (ID) depending on the selected guidewire strategy. Key secondary endpoints included VARC-3-defined complications.

Results: The study cohort included 398 patients of four tertiary care institutions, of whom 79.6% (317/398) had undergone TAVI using NLu and 20.4% (81/398) using Lu guidewires. Baseline characteristics did not substantially differ between NLu and Lu patients. The average ID was higher in the Lu cohort (NLu vs. Lu: -5.2 [-7.0-(-3.5)] vs. -4.5 [-6.0-(-3.0)]; p = 0.022^*). The optimal ID was reached in 45.0% of patients according to former and only in 20.1% according to nowadays best practice recommendations. There was no impact of the guidewire use on the 30-day outcomes, including conduction disturbances and pacemaker need (NLu vs. Lu: 15.1 vs. 18.5%; p = 0.706).

Conclusion: The use of the Lunderquist^TM guidewire was associated with a higher ID during TAVI with the STHV-34 without measurable benefits in the 30-day course concerning conduction disturbances and associated pacemaker need. Whether using different guidewires might impact the outcome in challenging anatomies should be further investigated in randomized studies under standardized conditions.

Keywords: TAVI; complications; elderly; implantation depth; outcome.