Division of Cardiovascular Surgery, Department of Surgery, Kurume University School of Medicine, 67 Asahi-Machi, Kurume-Shi, Fukuoka, 830-0011, Japan.
Division of Cardiovascular Medicine, Department of Internal Medicine, Kurume University School of Medicine, Kurume-Shi, Fukuoka, 830-0011, Japan.
Heart Vessels. 2024 Jan;39(1):48-56. doi: 10.1007/s00380-023-02307-z. Epub 2023 Aug 22.
The cusp overlap technique allows greater visual separation between the basal annular plane and the conduction system and decreases the permanent pacemaker implantation rate. We assessed the impact of the cusp overlap technique on conduction disturbance and paravalvular leakage after transcatheter aortic valve replacement. A total of 97 patients underwent transfemoral transcatheter aortic valve replacement with self-expandable valves at our institution from November 2018 to January 2023. The mean age of the patients was 85 years, and 23% were male. The patients were divided into two groups: the cusp overlap technique group and the non-cusp overlap technique group. We compared the clinical results between the two groups. The 30-day permanent pacemaker implantation rate was similar between the two groups (cusp overlap technique: 6.3% vs. non-cusp overlap technique: 10.2%, p = 0.48). The rate of new-onset conduction disturbance was slightly lower in the cusp overlap than non-cusp overlap technique group (18.8% vs. 34.7%, respectively; p = 0.08). The implanted valve function was similar between the two groups, but the rate of trivial or less paravalvular leakage (PVL) was significantly higher in the cusp overlap technique group on echocardiography (69% vs. 45%, p = 0.02). On multidetector computed tomography, the implantation depth at the membranous septum was significantly shorter in the cusp overlap technique group (2.0 ± 2.3 vs. 2.9 ± 1.5 mm, p = 0.02). The degree of canting was slightly smaller in the cusp overlap technique group (1.0 ± 2.2 vs. 1.7 ± 1.9 mm, p = 0.07). The relative risk of PVL equal to or greater than mild was 1.76 times higher for valve implantation without the cusp overlap technique (adjusted odds ratio, 3.74; 95% confidence interval, 1.45-9.69; p < 0.01). Transcatheter aortic valve replacement using the cusp overlap technique is associated with an optimized implantation depth, leading to fewer conduction disturbances. Optimal deployment may also maximize the radial force of self-expanding valves to reduce paravalvular leakage.
瓣叶搭接技术可以更好地区分瓣环基底部平面与传导系统，降低永久性心脏起搏器植入率。我们评估了经导管主动脉瓣置换术后瓣叶搭接技术对传导障碍和瓣周漏的影响。2018 年 11 月至 2023 年 1 月，我院对 97 例行经股动脉入路的自膨式瓣膜经导管主动脉瓣置换术的患者进行了研究。患者的平均年龄为 85 岁，23%为男性。患者分为瓣叶搭接技术组和非瓣叶搭接技术组。我们比较了两组患者的临床结果。两组患者 30 天内永久性心脏起搏器植入率无差异（瓣叶搭接技术组：6.3%，非瓣叶搭接技术组：10.2%，p=0.48）。瓣叶搭接技术组新发传导障碍的发生率略低于非瓣叶搭接技术组（18.8%对 34.7%，p=0.08）。两组植入瓣膜功能相似，但超声心动图显示瓣叶搭接技术组轻度或以下瓣周漏（PVL）发生率显著更高（69%对 45%，p=0.02）。多排 CT 显示瓣叶搭接技术组在膜性间隔的植入深度明显更浅（2.0±2.3 对 2.9±1.5mm，p=0.02）。瓣叶搭接技术组的倾斜度稍小（1.0±2.2 对 1.7±1.9mm，p=0.07）。无瓣叶搭接技术时，PVL 等于或大于轻度的相对风险为 3.74 倍（校正比值比，1.76；95%置信区间，1.45-9.69；p<0.01）。经导管主动脉瓣置换术中使用瓣叶搭接技术与优化的植入深度相关，从而减少传导障碍。优化的植入还可能使自膨式瓣膜的径向力最大化，从而减少瓣周漏。
