New Meta-Analysis Confirms Cusp Overlap Technique Improves Clinical Outcomes in TAVR with Self-Expanding Valves

Jul 04, 2025 08:01 CST Updated 08:01

Medtronic

Medical Device Manufacturer

According to the publication in "Journal of the American College of Cardiology》A new meta-analysis onUse of the Cusp Overlap Technique During Transcatheter Aortic Valve Replacement (TAVR) and Self-Expanding Valve Implantation Significantly Reduces the Risk of Permanent Pacemaker Implantation (PPMI) and Helps Patients Return Home Faster。[1]

"TAVR has become the preferred treatment for symptomatic aortic stenosis, but conduction disturbances leading to PPMI remain an important complication, especially for self-expanding valves, introducing a cusp compared with the traditional co-planar view (CPV)."

Cusp overlapFig. (COV) technology to achieve higher and more controlled valve implantation."

Hazique et al. explored data from 14 different single-center clinical trials, focusing on more than 5,000 TAVR patients treated between 2015 and 2023. Most patients received Medtronic's self-expanding Evolut, Evolut PRO, or Evolut PRO+ TAVR valves.

The trials included in this meta-analysis covered patients who underwent TAVR in the United States, Japan, Germany, Spain, Portugal, Canada, India, and Turkey. The authors noted that these patients were often at low or intermediate risk, and the majority were treated via transfemoral access.

Overall, among 5,266 patients, 53.4% underwent TAVR and COV, while the remaining 46.6% underwent TAVR and CPV. The primary outcome of the study, PPMI, occurred in 11.2% of patients in the COV group and 17.7% of patients in the CPV group. Additionally, patients in the COV group had shorter hospital stays (standardized mean difference: -0.56) and a slightly lower mean transvalvular gradient.

The enhanced visualization provided by COV allows for precise identification of the lowest points of the aortic annulus and membranous septum, thereby reducing parallax and perspective contraction.This optimal positioning reduces mechanical injury to the conduction system, especially the His bundle, which in turn lowers the risk of conduction disturbances and the need for PPMI.These results not only have the potential to improve patient outcomes and reduce the utilization of healthcare resources, but also set a benchmark for the standardization of TAVR protocols in clinical practice.

The team did emphasize certain limitations of their research. For example, these were observational studies conducted at a single institution, and the authors could not determine whether patients treated later might have benefited from improvements in TAVR technology. Additionally, since so many patients received self-expanding TAVR valves, this study may not be relevant to patients receiving balloon-expandable valves.

Reference:

Mohammad Hazique, MD, Zubair Jafar, MD, Sameer Lohana, MD, et al. The Cusp Overlap Technique Reduces Pacemaker Implantation in TAVR – A systematic review and meta-analysis. The American Journal of Cardiology June 27, 2025.