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ORIGINAL RESEARCH article

Front. Cardiovasc. Med.
Sec. Cardiovascular Surgery
Volume 12 - 2025 | doi: 10.3389/fcvm.2025.1486375

Predictors of Permanent Pacemaker Requirement in Aortic Stenosis Patients Undergoing Self-Expanding Valve Transcatheter Aortic Valve Replacement Using the Cusp Overlap Technique

Provisionally accepted
Yung-Tsai Lee Yung-Tsai Lee 1,2Tien Ping Tsao Tien Ping Tsao 1,3Kuo Chen Lee Kuo Chen Lee 1Huan-Chiu Lin Huan-Chiu Lin 1Chun-Ting Liu Chun-Ting Liu 1*Ming-Chon Hsiung Ming-Chon Hsiung 1*Wei-Hsian Yin Wei-Hsian Yin 1,4Jeng Wei Jeng Wei 1,3*
  • 1 Heart Center, Cheng Hsin General Hospital, Taipei, Taiwan
  • 2 Department of Exercise and Health Science, National Taipei University of Nursing and Health Sciences, Taipei City, Taipei County, Taiwan
  • 3 Department of Medicine, National Defense Medical Center, Taipei, Taiwan
  • 4 School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan

The final, formatted version of the article will be published soon.

    Introduction: Since TAVR was approved for lower-risk aortic stenosis (AS) patients, managing post-implantation conduction disturbances has become crucial, especially with self-expanding heart valves (SEV). This study aims to identify risk factors for conduction disturbances in such patients using a specific fluoroscopic cusp overlap (COL) technique. Methods: This retrospective study analyzed AS patients who underwent TAVR with SEV from 2019 to 2022, excluding those needing pacemakers or valve-in-valve procedures. Patients were grouped by conventional (CON) and COL techniques, with outcomes monitored using Valve Academic Research Consortium (VARC)-2 criteria. Results: In this cohort study of 114 patients, 17 were excluded due to pre-existing pacemakers. Forty-seven received SEVs using COL, and 50 with CON techniques. The COL group showed a significant reduction in new LBBB (27.7% vs. 46%, p=0.006) and PPI rates (4.3% vs. 18%, p=0.033) compared to the CON group. Deeper implantation depth below the non-coronary cusp (NCC) and left coronary cusp (LCC) was linked to an increased risk of conduction disturbances. Multivariate analysis identified smaller left ventricular outflow tract diameter, shorter membranous septum length, and greater pre-releasing implantation depth below the LCC as predictors of future PPI risk. Conclusion: The use of the COL technique significantly reduces the risk of newly developed conduction disturbances after SEV TAVR. Keeping SEV implantation depth within 1 mm of the membranous septum length and maintaining an implantation depth of < 6 mm below the LCC before final release further minimizes the risk of PPI.

    Keywords: Transcatheter aortic valve replacement, self-expanding valves, cusp overlap technique, Conduction disturbances, Permanent pacemaker implantation

    Received: 04 Sep 2024; Accepted: 03 Feb 2025.

    Copyright: © 2025 Lee, Tsao, Lee, Lin, Liu, Hsiung, Yin and Wei. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

    * Correspondence:
    Chun-Ting Liu, Heart Center, Cheng Hsin General Hospital, Taipei, Taiwan
    Ming-Chon Hsiung, Heart Center, Cheng Hsin General Hospital, Taipei, Taiwan
    Jeng Wei, Heart Center, Cheng Hsin General Hospital, Taipei, Taiwan

    Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.