AUTHOR=Veulemans Verena , Wilde Nihal , Wienemann Hendrik , Adrichem Rik , Hokken Thijmen W. , Al-Kassou Baravan , Shamekhi Jasmin , Mauri Victor , Maier Oliver , Jung Christian , Horn Patrick , Adam Matti , Nickenig Georg , Baldus Stephan , Van Mieghem Nicolas M. , Kelm Malte , Sedaghat Alexander , Zeus Tobias TITLE=Impact of different guidewires on the implantation depth using the largest self-expandable TAVI device JOURNAL=Frontiers in Cardiovascular Medicine VOLUME=9 YEAR=2023 URL=https://www.frontiersin.org/journals/cardiovascular-medicine/articles/10.3389/fcvm.2022.1064916 DOI=10.3389/fcvm.2022.1064916 ISSN=2297-055X ABSTRACT=Background

The deployment process of the largest self-expandable device (STHV-34) during transcatheter aortic valve implantation (TAVI) might be challenging due to stabilization issues. Whether the use of different TAVI-guidewires impact the procedural success and outcome is not well-known. Therefore, we sought to evaluate the impact of non-Lunderquist (NLu) vs. the Lunderquist (Lu) guidewires during TAVI using the STHV-34 on the procedural and 30-day outcomes.

Methods

The primary study endpoint was defined as the final implantation depth (ID) depending on the selected guidewire strategy. Key secondary endpoints included VARC-3-defined complications.

Results

The study cohort included 398 patients of four tertiary care institutions, of whom 79.6% (317/398) had undergone TAVI using NLu and 20.4% (81/398) using Lu guidewires. Baseline characteristics did not substantially differ between NLu and Lu patients. The average ID was higher in the Lu cohort (NLu vs. Lu: −5.2 [−7.0–(−3.5)] vs. −4.5 [−6.0–(−3.0)]; p = 0.022*). The optimal ID was reached in 45.0% of patients according to former and only in 20.1% according to nowadays best practice recommendations. There was no impact of the guidewire use on the 30-day outcomes, including conduction disturbances and pacemaker need (NLu vs. Lu: 15.1 vs. 18.5%; p = 0.706).

Conclusion

The use of the LunderquistTM guidewire was associated with a higher ID during TAVI with the STHV-34 without measurable benefits in the 30-day course concerning conduction disturbances and associated pacemaker need. Whether using different guidewires might impact the outcome in challenging anatomies should be further investigated in randomized studies under standardized conditions.