SynthesisFrontiers in cardiovascular medicine2026
Systematic review, meta-analysis of cusp-overlap vs. three-cusp coplanar approaches in self-expandable transcatheter aortic valve replacement.
Synthesis in Frontiers in cardiovascular medicine, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Authors and funding
11 authors.
Funding
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Abstract
Background: The cusp-overlap technique (COT) is an alternative fluoroscopic approach to the standard three-cusp technique (ST) in self-expandable transcatheter aortic valve replacement (TAVR). It may improve implantation depth and reduce conduction disturbances, but its overall clinical benefit remains unclear. Objectives: To compare the safety and efficacy of COT vs. ST in terms of mortality, conduction disturbances, permanent pacemaker implantation (PPI), and cerebrovascular accidents (CVA). Methods: This systematic review and meta-analysis followed PRISMA guidelines. PubMed, Cochrane, Scopus, Embase, and Web of Science were searched up to October 2025. Studies comparing COT and ST were included. Data extraction and risk-of-bias assessment were performed independently. Meta-analysis was conducted using R with fixed- and random-effects models. Outcomes included mortality (by follow-up), conduction disturbances, PPI, and CVA. The protocol was registered in PROSPERO (CRD420251156402). Results: Eighteen studies were analyzed, with patient numbers varying by outcome (mortality: 5,984 patients; conduction disturbances: 7,200 patients; PPI: 5,712 patients; CVA: 4,066 patients). COT significantly reduced mortality compared with ST (OR: 0.60, 95% CI: 0.40-0.88; Conclusion: COT in self-expandable TAVR is associated with lower rates of conduction disturbances and PPI, and reduced short-term mortality, without increasing cerebrovascular risk. While these findings are consistent and clinically plausible, the overall certainty of evidence is limited. COT appears to be a promising procedural refinement, but further randomized studies are needed to confirm long-term benefits. Systematic Review Registration: identifier CRD420251156402.
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