Impacto de la técnica de Cusp-Overlap en el requerimiento de marcapasos luego de un implante valvular aórtico percutáneo.
2021
espanolIntroduccion: Las bradiarritmias persistentes que requieren el implante de un marcapasos definitivo son una complicacionfrecuente tras el implante valvular aortico percutaneo (IVAP), pero un implante alto con tecnica Cusp-Overlap podria evitarlas alteraciones del sistema de conduccion.Objetivo: El objetivo fue determinar la tasa de uso de marcapasos en pacientes que recibieron IVAP con la tecnica convencionalcoplanar en comparacion con Cusp-Overlap.Material y metodos: Entre 2017 y 2019 se analizaron 65 pacientes consecutivos de dos centros, que recibieron valvulas Evolut-R o Evolut-Pro: 50 implante coplanar y 15 Cusp-Overlap.Resultados: La edad promedio era 80 anos y no hubo diferencias en el riesgo por puntaje EuroSCORE. Los procedimientos conla tecnica de Cusp-Overlap presentaron 0% de requerimiento de marcapasos en comparacion con 24,9% en el implante convencional(p = 0,041). Tambien hubo menos complicaciones mayores (6,67% vs 42%; OR = 0,09; IC 95% 0,01-0,8; p = 0,011).Conclusiones: En esta cohorte el IVAP con la tecnica de Cusp-Overlap se asocio con una necesidad de marcapasos nula. Dadoel potencial impacto a gran escala se necesita validar externamente los resultados obtenidos. EnglishBackground: Persistent bradyarrhythmias requiring permanent pacemaker implantation are a common complication aftertranscatheter aortic valve implantation (TAVI), but high implantation with cusp-overlap technique could prevent conductionsystem disturbances.Objective: The aim of this study was to assess the rate of pacemaker use in patients who received TAVI with conventionalcoplanar technique compared with cusp-overlap technique.Methods: A total of 65 consecutive patients from two centers receiving Evolut-R or Evolut-Pro valve implantation, 50 coplanarand 15 cusp-overlap, were analyzed between 2017 and 2019.Results: Mean age was 80 years, and there were no differences in risk according to the EuroSCORE. The rate of pacemakerrequirement was 0% in cusp-overlap procedures compared with 24.9% in those with conventional implantation; p=0.041).In addition, cusp-overlap implants presented lower rate of major complications (6.67% vs. 42%; OR=0.09; 95% CI 0.01-0.8;p=0.011).Conclusions: In this cohort, TAVI procedure with cusp-overlap technique was associated with null pacemaker requirement.Given the potential large-scale impact, external validation of results is needed.
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