Transcatheter Aortic Valve Implantation (TAVI) is a life-saving procedure for patients with aortic stenosis who are not candidates for conventional surgery. The technique has seen significant advancements since its inception in 2002, with evolving methods aiming to improve outcomes and reduce complications. A recent Indian study, published in the Indian Heart Journal, extensively investigates the effectiveness of two different TAVI techniques in Indian patients – the conventional tricusp coplanar (CON) and the newer cuspal overlap (COT) view techniques.

DOI: 10.1016/j.ihj.2024.01.007

Background

Aortic stenosis is one of the most common valvular heart diseases, especially in the elderly. TAVI has emerged as a less invasive alternative to open-heart surgery, especially for those at high surgical risk. In efforts to decrease conduction disturbances and pacemaker implantation rates post-TAVI, different fluoroscopic techniques are used for optimal valve placement.

Study Parameters

The study, led by Dr. Rajat Datta of AHRR Cardiology Department in Delhi, India, and his research team, enrolled 111 patients who underwent TAVI using the self-expanding Core Valve Evolut R or Evolut PRO between January 2017 and September 2022. The analysis compared traditional coplanar technique in 55 patients with the cuspal overlap technique in 56 patients.

Baseline Characteristics and Methodology

Baseline characteristics and electrocardiographic findings were similar across both groups, facilitating a fair comparison of the procedural outcomes. The majority of procedures were performed under conscious sedation and both predilatation and postdilatation were utilized nearly equally among both techniques.

Key Findings

The study’s findings presented a compelling case for the COT technique, which showed lower rates of permanent pacemaker implantation (PPI) at 90 days. Additionally, the average time for PPI post-procedure was shorter, and fewer patients developed new onset left bundle branch block (LBBB). Although the valve deployment time was longer in the COT group, the all-cause mortality at 3 months was significantly lower compared to the CON group.

Despite these positive results, the COT group experienced higher stroke rates and pericardial effusions, presenting a complex consideration for clinicians who must weigh the benefits against the potential risks.

Clinical Implications

The findings of this study hold significant clinical implications. A lower rate of PPI can lead to improved patient outcomes and reduced healthcare costs. However, the increased likelihood of stroke and pericardial effusions cannot be overlooked. Long-term data and further research might help to refine the COT technique to minimize such risks.

References

1. Datta, R., Bharadwaj, P., Keshavamurthy, G., Guleria, V. S., Ratheesh, K. J., & Abbot, A. K. (2024). Transcatheter aortic valve implantation using coplanar and cuspal overlap techniques in Indian patients. Indian Heart Journal. https://doi.org/10.1016/j.ihj.2024.01.007
2. Cribier, A., Eltchaninoff, H., Bash, A., et al. (2002). Percutaneous Transluminal Valvuloplasty of Aortic Stenosis, A New Approach to Aortic Valve Stenosis. European Heart Journal.
3. Van Mieghem, N. M., El Faquir, N., Rahhab, Z., et al. (2020). Incidence and Predictors of Permanent Pacemaker Implantation After Transcatheter Aortic Valve Replacement: A Single-Center Experience. JACC: Cardiovascular Interventions.
4. Deeb, G. M., Reardon, M. J., Chetcuti, S., et al. (2017). 3-Year Outcomes in High-Risk Patients Who Underwent Surgical or Transcatheter Aortic Valve Replacement. Journal of the American College of Cardiology.
5. Popma, J. J., Deeb, G. M., Yakubov, S. J., et al. (2019). Transcatheter Aortic-Valve Replacement with a Self-Expanding Valve in Low-Risk Patients. The New England Journal of Medicine.

Keywords

1. Transcatheter Aortic Valve Implantation India
2. TAVI Techniques Comparison
3. Cuspal Overlap Technique TAVI
4. Permanent Pacemaker Post-TAVI
5. Aortic Stenosis Treatment Innovations

Conclusion

The collaborative efforts of Datta and his team offer crucial insights into the evolution of TAVI techniques. By refining these methods, healthcare providers can better tailor treatments to individual patient needs, maximizing benefits while minimizing risks. As the body of evidence grows, the conversation surrounding optimal TAVI techniques will continue to be a dynamic and critical aspect of cardiovascular intervention, particularly within the diverse Indian patient population.