Implantation Depth in TAVR Procedures Influences Outcomes Reporting: Study

Optimal implant depth (OID) during transcatheter aortic valve replacement (TAVR) occurs about a third of the time, a new study indicates.

The authors, seeking to characterize how the calculation of implant depth for TAVR could impact clinical and hemodynamic outcomes reporting for patients undergoing TAVR with a self-expanding device. The study was undertaken in part because there exist different approaches to OID that may have influence over uniform reporting, coupled with the fact that current updated guidelines (Valve Academic Research Consortium, or VARC-2 guidelines) do not include instructions for implant depth.

The study included 258 patients undergoing TAVR with a third-generation self-expanding device. The authors analyzed various methods used to assess implant depth using mean of the measured distances from the noncoronary cusp and the left coronary cusp to the distal prosthesis end; noncoronary cusp distance, the distance from the noncoronary cusp to the distal prosthesis end; and deepest edge, the deepest edge of the distal prosthesis end.

According to the study results, OID was reached in less than 30% of cases (arithmetic mean, 25.4%; noncoronary cusp distance, 28.4%; deepest edge, 20.5%; P=0.008). They also reported that the deepest edge method was the most stringent in differentiating relevant outcome parameters (for example, permanent pacemaker implantation). Hemodynamic outcome (mean pressure gradient reduction after TAVR) was not affected, they reported.

“The OID was reached in <30% of TAVR procedures,” the authors concluded. “The various methods applied for implant depth calculation significantly influence the outcome reporting and do not allow a uniform perception of the implant depth.”

The study was published in JACC Cardiovascular Interventions.