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Cusp Overlap Technique: Should It Become the Standard Implantation Technique for Self-expanding Valves?

  • New Therapies for Cardiovascular Disease (AA Bavry and MR Massoomi, Section Editors)
  • Published:
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Abstract

Purpose of Review

Accurate imaging of the aortic root during valve implantation is crucial for proper prosthesis positioning during TAVR. The purpose of this review was to determine if routine use of the cusp-overlap view should be adopted for self-expanding valves.

Recent Findings

The use of the cusp-overlap view with the Evolut, Portico, ACURATE neo/neo2, and JenaValve systems is associated with lower post-procedural new permanent pacemaker implantation rates when compared with the standard 3-cusp view, presumably due to more precise valve implantation relative to the conduction system by the non-coronary cusp.

Summary

By elongating the left ventricular outflow tract and accentuating the right-non commissure in the center of the fluoroscopic view, the cusp-overlap technique allows operators to more precisely control the prosthesis implant depth during self-expanding valve deployment. While the early experience with this approach in Evolut TAVR has been promising, the results of larger studies with longer follow-up across multiple self-expanding systems are warranted.

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Authors and Affiliations

  1. Department of Cardiovascular Surgery, The Mount Sinai Hospital, New York, NY, USA

    Aditya Sengupta, Sophia L. Alexis, Timothy Lee & Gilbert H. L. Tang

  2. Division of Cardiology, Westchester Medical Center, Valhalla, NY, USA

    Syed Zaid

  3. Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA

    Parasuram M. Krishnamoorthy, Sahil Khera, Stamatios Lerakis, Malcolm Anastasius, George D. Dangas, Samin K. Sharma & Annapoorna S. Kini

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  1. Aditya Sengupta
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Correspondence to Gilbert H. L. Tang.

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Conflict of Interest

Dr. Khera is a consultant for Abbott Structural Heart, Medtronic, and Boston Scientific, and has received speakers’ honoraria from Medtronic. Dr. Dangas is on the advisory board and is a consultant for Boston Scientific and has common stock with Medtronic that is fully divested. Dr. Sharma has served on the Speakers Bureau for Abbott Vascular, Boston Scientific, TriReme, and Cardiovascular Systems. Dr. Tang has served as a physician proctor for Medtronic and is a consultant for Medtronic and Abbott Structural Heart. The other authors have no conflicts of interest to declare.

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All reported studies/experiments with human or animal subjects performed by the authors have been previously published and complied with all applicable ethical standards (including the Helsinki declaration and its amendments, institutional/national research committee standards, and international/national/institutional guidelines).

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Sengupta, A., Alexis, S.L., Lee, T. et al. Cusp Overlap Technique: Should It Become the Standard Implantation Technique for Self-expanding Valves?. Curr Cardiol Rep 23, 154 (2021). https://doi.org/10.1007/s11886-021-01583-3

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