Servicio de Cardiología, Hospital de la Santa Creu i Sant Pau, Instituto de Investigación Biomédica Sant Pau, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain.
Servicio de Cardiología, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain.
Rev Esp Cardiol (Engl Ed). 2023 Oct;76(10):767-773. doi: 10.1016/j.rec.2023.02.003. Epub 2023 Feb 17.
The cusp overlap technique (COT) has been proposed to reduce conduction disturbances (CD) after transcatheter aortic valve implantation (TAVI) with self-expanding supra-annular devices, but there are scarce data on COT with intra-annular valves. The aim of this study was to determine whether the use of the COT during Portico implantation results in higher valve implantation and lower rates of CD.
We included 85 patients undergoing TAVI with the Portico FlexNav system: 43 retrospective patients using the standard 3-cusp view and 42 prospective patients with the COT. Primary endpoints were implantation depth and new-onset CD (composite outcome of new-onset left bundle branch block and new permanent pacemaker implantation).
COT resulted in a higher implantation depth (noncoronary cusp: 4.9±3.9 vs 7.4±3.0; P=.005) and lower new-onset CD (31.0% vs 58.1%; P=.012), with a tendency toward a lower need for permanent pacemaker implantation (14.3% vs 30.2%, P=.078; 7.7% vs 31.0%; P=.011 in patients without pre-existing right bundle branch block). Transvalvular aortic gradients were slightly lower with COT (8.7±3.7 vs 11.0±6.1; P=.044). There were no differences in technical success or major procedure-related complications. On multivariate analysis, COT use was associated with a lower risk of new-onset CD.
Use of the COT during Portico implantation is feasible and facilitates a higher valve implant, which in turn may help to reduce rates of new-onset CD.
在使用自膨式瓣环上瓣膜行经导管主动脉瓣置换术（TAVI）时，提出了嵴重叠技术（COT）以减少传导障碍（CD），但关于瓣环内瓣膜的 COT 数据很少。本研究的目的是确定在 Portico 植入过程中使用 COT 是否会导致更高的瓣膜植入和更低的 CD 发生率。
我们纳入了 85 例接受 Portico FlexNav 系统 TAVI 的患者：43 例回顾性患者使用标准的 3 叶视图，42 例前瞻性患者使用 COT。主要终点是植入深度和新发 CD（新发左束支传导阻滞和新永久性起搏器植入的复合结果）。
COT 导致更高的植入深度（非冠状动脉嵴：4.9±3.9 vs 7.4±3.0；P=.005）和更低的新发 CD（31.0% vs 58.1%；P=.012），且永久性起搏器植入的需求较低（14.3% vs 30.2%，P=.078；7.7% vs 31.0%；在无预先存在的右束支传导阻滞的患者中 P=.011）。COT 时跨瓣主动脉梯度略低（8.7±3.7 vs 11.0±6.1；P=.044）。技术成功率和主要手术相关并发症无差异。多变量分析显示，COT 的使用与新发 CD 的风险降低相关。
在 Portico 植入过程中使用 COT 是可行的，有助于提高瓣膜植入率，从而有助于降低新发 CD 的发生率。
