Cusp‐overlap versus coplanar view in transcatheter aortic valve implantation with self‐expandable valves: A meta‐analysis of comparative studies

• Published in: Catheterization and cardiovascular interventions Vol. 101; no. 3; pp. 639 - 650
• Main Authors: Sá, Michel Pompeu, Van den Eynde, Jef, Jacquemyn, Xander, Erten, Ozgun, Dokollari, Aleksander, Sicouri, Serge, Ramlawi, Basel
• Format: Journal Article
• Language: English
• Published: United States Wiley Subscription Services, Inc 01.02.2023
• Subjects: Aortic valve; Aortic Valve - diagnostic imaging; Aortic Valve - surgery; Aortic Valve Stenosis - complications; Aortic Valve Stenosis - diagnostic imaging; Aortic Valve Stenosis - surgery; Arrhythmias, Cardiac - etiology; Bundle-Branch Block - etiology; cardiac surgical procedures; cardiovascular surgical procedures; Dislocation; Heart Valve Prosthesis - adverse effects; heart valve prosthesis implantation; Heart Valve Prosthesis Implantation - adverse effects; heart valves; Humans; Meta-analysis; Mortality; Pacemakers; Statistical analysis; Surgery; transcatheter aortic valve replacement; Transcatheter Aortic Valve Replacement - adverse effects; Treatment Outcome; meta-analysis; transcatheter aortic valve replacement; heart valve prosthesis implantation; heart valves; cardiac surgical procedures; cardiovascular surgical procedures
• ISSN: 1522-1946; 1522-726X
• DOI: 10.1002/ccd.30562

Background Permanent pacemaker implantation (PPI) is a common complication after transcatheter aortic valve implantation (TAVI). The cusp‐overlap view (COV) was adopted to reduce PPI risk after TAVI with self‐expandable valves (SEVs); however, the evidence remains scarce. We performed a systematic review with meta‐analysis comparing COV and the standard coplanar view (CPV) technique to evaluate their effectiveness and safety. Methods Following the PRISMA statement, data were extracted from studies published by August 2022 and found in PubMed/MEDLINE, EMBASE, CENTRAL/CCTR, ClinicalTrials.gov, SciELO, LILACS, and Google Scholar. The primary outcome of interest was post‐procedural PPI and the secondary outcomes were new left bundle branch block (LBBB), moderate/severe paravalvular leak (PVL), valve dislocation (pop‐out); need of second transcatheter heart valve, 30‐day mortality, stroke, conversion to surgery, coronary obstruction, implantation depth (mm), and post‐TAVI mean gradients (mmHg). Results Eleven studies met our eligibility criteria and included 1464 patients in the COV group and 1743 patients in the CPV group. Patients who underwent TAVI with COV had lower risk of PPI (odds ratio 0.48; 95% confidence interval [CI] 0.33–0.70; p = 0.001) and higher implantation depths with COV (mean difference −0.83; 95% CI −1.2 to −0.45; p < 0.001). We did not observe any statistically significant differences in the rates of new LBBB, moderate/severe PVL, valve dislocation, need of second transcatheter heart valve, 30‐day mortality, stroke, conversion to surgery, coronary obstruction, and post‐TAVI mean gradients (mmHg). Conclusion In TAVI with SEVs, the application of COV is associated with lower risk of PPI compared with the standard CPV without increasing risk for adverse outcomes.