Transcatheter Aortic Valve Implantation (TAVI)

Cusp overlap technique

Driving consistency in your TAVI procedures

Evolut transcatheter aortic valve being deployed using cusp overlap technique


Facilitate implant depth accuracy
The cusp overlap technique isolates the noncoronary cusp (NCC) to provide an accurate anatomical view to assess and achieve the target implant depth.1


Predictable valve deployment
Slow deployment starting at the supra-annular level allows the valve to descend to its target position with minimal catheter manipulation.

Optimize PRO interim clinical analysis1

Optimize PRO Study investigators use the cusp overlap technique and a prespecified conduction disturbance pathway, which contributes to excellent clinical outcomes, such as a single-digit pacemaker rate.*

  • 0 deaths or disabling strokes at 30 days
  • 0% moderate or severe PVL at discharge
  • 8.8% permanent pacemaker rate at 30 days
  • 8.1 mm Hg gradient at discharge
  • 1 day median length of stay

Predictable precision

Accurate depth assessment at the NCC, facilitated with the cusp overlap technique, has resulted in single-digit pacemaker rates in several single-center and multicenter clinical studies.

Single-digit new 30-day permanent pacemaker implantation rates

Bar chart highlighting 30-day pacemaker implant rates for multiple studies following TAVR or TAVI, depending on region or country

Excludes patients with baseline implantable cardioverter defibrillator or pacemaker.

TAVI risks may include, but are not limited to, death, stroke, damage to the arteries, bleeding, and need for permanent pacemaker.

Watch the cusp overlap technique on Medtronic Academy.

Related pages

Explore our other procedural guidance and outcomes you can expect from the Evolut platform.
Evolut transcatheter aortic valve with catheter accessing the coronary

Post-TAVI coronary access

Review the guidance
Evolut 29 mm transcatheter aortic valve within a circular outline

Durability starts with design

Explore our design
Top-down view of the Evolut transcatheter aortic valve within a circular outline

Comprehensive clinical evidence

Explore the data

This is an interim analysis of 171 patients (71 roll-in and 100 main cohort). At the conclusion of the study, more than 600 patients will have been evaluated.

Discharge rates.



Grubb K, et al. An Optimized TAVR Care Pathway Using Evolut™ PRO and PRO+ Early Results from the Optimized PRO Study. Presented at SCAI 2021.


Gada H. TAVR in Low Risk Patients. Presented at TVT 2019.


Gada H, et al. Reduction of Rates of Permanent Pacemaker Implantation With 34-MM Evolut™ R Using Cusp Overlap Technique. Presented at TCT Connect 2020.


Gada H, et al. Reproducibility of Cusp Overlap Technique to Reduce Permanent Pacemaker Implantation With Evolut™: The Latin American Experience. Presented at TCT Connect 2020.


Pisaniello AD, Makki HBE, Jahangeer S, Daniels MJ, Hasan R, Fraser DGW. Low Rates of Permanent Pacing Are Observed Following Self-Expanding Transcatheter Aortic Valve Replacement Using an Annular Plane Projection for Deployment. Circ Cardiovascular Interv. January 2021;14(1):e009258.


Mendiz OA, Noč M, Fava CM, et al. Impact of Cusp-Overlap View for TAVR with Self-Expandable Valves on 30 Day Conduction Disturbances, J Interv Cardiol. April 28, 2021;2021:9991528.