SPC365

Exploring Implantation Depth and procedural outcomes in Transcatheter Aortic Valve Replacement

Session: SESSÃO DE COMUNICAÇÕES ORAIS 08 – OTIMIZAR RESULTADOS NA TAVI: PERFIL DO DOENTE, TÉCNICAS E VÁLVULAS
Speaker: Miguel Caramelo Abrantes de Figueiredo

Congress: CPC 2025
Topic: F. Valvular, Myocardial, Pericardial, Pulmonary, Congenital Heart Disease
Theme: 15. Valvular Heart Disease
Subtheme: 15.4 Valvular Heart Disease – Treatment
Session Type: Comunicações Orais
FP Number: ---
Authors: Miguel Abrantes De Figueiredo; Inês Rodrigues; Fernando Ferreira; Francisco Cardoso; Mariana Coelho; Francisco Albuquerque; André Grazina; Tiago Mendonça; António Fiarresga; Rúben Ramos; Rui Cruz Ferreira; Duarte Cacela

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:12.0pt"><span style="font-family:&quot;Times New Roman&quot;,serif">Background:</span></span></strong><span style="font-size:12.0pt"><span style="font-family:&quot;Times New Roman&quot;,serif"> Contemporary evidence showed an influence of transcatheter heart valve implantation depth (ID) on a multitude of outcomes, including conduction disturbances (CD) requiring permanent pacemaker implantation (PPI) and paravalvular leakage (PVL). However, a standardized protocol for determining and reporting ID in Transcatheter Aortic Valve Replacement (TAVR) is not so well established.</span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:12.0pt"><span style="font-family:&quot;Times New Roman&quot;,serif">Purpose: </span></span></strong><span style="font-size:12.0pt"><span style="font-family:&quot;Times New Roman&quot;,serif">To evaluate the ID and short-term procedural outcomes of patients undergoing TAVR with self-expandable transcatheter valves.</span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:12.0pt"><span style="font-family:&quot;Times New Roman&quot;,serif">Methods: </span></span></strong><span style="font-size:12.0pt"><span style="font-family:&quot;Times New Roman&quot;,serif">A retrospective analysis of the procedural angiograms of patients that underwent TAVR with self-expandable valves between January 2023 and November 2024 in a single high-volume tertiary center in Portugal was performed. ID was measured at the level of the non-coronary cusp (NCC) and the left coronary cusp (LCC) in the final aortic root angiogram in a left-anterior-oblique projection. Moreover, 2 additional categories were created: the arithmetic mean (AM) and the greatest value of the ID values obtained. Optimal implantation depth was defined according to the manufacturer&rsquo;s recommendations. PPI and echocardiographic evaluation were performed according to the current indications and institutional protocols.</span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:12.0pt"><span style="font-family:&quot;Times New Roman&quot;,serif">Results:</span></span></strong><span style="font-size:12.0pt"><span style="font-family:&quot;Times New Roman&quot;,serif"> Of the 170 patients included, 102 underwent TAVR with the <em>Evolut Pro/Pro+</em> platform and the remaining patients with the <em>Navitor</em> platform. A mean NCC ID of 6.18mm and a mean LCC ID of 6.98mm was determined, with no statistically significant differences regarding the platform or the valve size utilized. Optimal ID was obtained in 11.8% to 23.5% of cases and a deep valve positioning was the most frequent result (<strong>FIGURE 1</strong>). Cusp Overlap Technique was the fluoroscopic approach used by default with corrective measures done with the 3 Cusp View in 25.3% of cases (without differences in the overall ID between those groups). There was a PPI rate of 35.9%, with a significantly deeper valve positioning across all measuring categories (p &lt; 0.01) in this group. Optimal ID at the NCC was associated with the absence of CD requiring PPI (Chi-Square analysis, p = 0.012). Shallow valve implantation was associated with significant PVL (Fisher&rsquo;s Exact Test, p &lt; 0.01).</span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:12.0pt"><span style="font-family:&quot;Times New Roman&quot;,serif">Conclusion:</span></span></strong><span style="font-size:12.0pt"><span style="font-family:&quot;Times New Roman&quot;,serif"> ID is a procedural metric that influences hemodynamic and electrophysiological outcomes. A sub-optimal deeper valve positioning was associated with PPI and a sub-optimal shallower valve placement was associated with significant PVL.</span></span></span></span></p>