Cusp-Overlapping Projections in TAVR : Where the Left Meets the Right

Transcatheter aortic valve replacement (TAVR) is now recommended across the risk spectrum for symptomatic patients with severe aortic valve stenosis. It is commonly a preferred approach for those ≥65 years of age if the transfemoral approach is feasible and after heart team discussion. Historically, TAVR has carried a higher risk for permanent pacemaker implantation (PPMI) compared with surgical aortic valve replacement (SAVR), a risk that has become key in the decision-making process between TAVR and SAVR, especially for self-expanding (SE) transcatheter heart valves (THVs). Among low-risk patients, the rate of PPMI is almost 3-fold higher using SE THVs compared with SAVR, while it remains similar to that with SAVR using balloon-expandable THV.

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Patient-specific best practice for device positioning is of paramount importance. It includes careful preprocedural imaging assessment using dedicated CT for the planning of periprocedural projections to be used for optimal THV release. In this winning plan, COP is definitely a procedural improvement, especially for SE THV implantation.