TY - JOUR
T1 - Cusp Overlap Technique
T2 - Should It Become the Standard Implantation Technique for Self-expanding Valves?
AU - Sengupta, Aditya
AU - Alexis, Sophia L.
AU - Lee, Timothy
AU - Zaid, Syed
AU - Krishnamoorthy, Parasuram M.
AU - Khera, Sahil
AU - Lerakis, Stamatios
AU - Anastasius, Malcolm
AU - Dangas, George D.
AU - Sharma, Samin K.
AU - Kini, Annapoorna S.
AU - Tang, Gilbert H.L.
N1 - Publisher Copyright:
© 2021, The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.
PY - 2021/11
Y1 - 2021/11
N2 - 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.
AB - 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.
KW - Aortic stenosis
KW - Commissural alignment
KW - Cusp-overlap
KW - Permanent pacemaker implantation
KW - Self-expanding
KW - Transcatheter aortic valve replacement
UR - https://www.scopus.com/pages/publications/85116344642
U2 - 10.1007/s11886-021-01583-3
DO - 10.1007/s11886-021-01583-3
M3 - Review article
C2 - 34599425
AN - SCOPUS:85116344642
SN - 1523-3782
VL - 23
JO - Current Cardiology Reports
JF - Current Cardiology Reports
IS - 11
M1 - 154
ER -