Transcatheter Aortic Valve Replacement Using the Repositionable LOTUS Valve: United Kingdom Experience.

Abstract

OBJECTIVES:

This study sought to present the U.K. experience to date with the second-generation LOTUS bioprosthesis (Boston Scientific, Natick, Massachusetts).

BACKGROUND:

First-generation transcatheter aortic valves have limitations. Second-generation repositionable valves may improve on some of those limitations.

METHODS:

Prospectively collected data relating to procedural and in-hospital outcome was analyzed from 10 implantation centers in the United Kingdom.

RESULTS:

Implants in 228 patients age 81.4 ± 7.6 years were studied; 53.5% were male. Mean logistic EuroScore was 17.5 ± 12.4. One hundred eighty-seven (82.0%) were undertaken for aortic stenosis, 7 (3.1%) for aortic regurgitation, and 34 (14.9%) for mixed aortic valve disease. A total of 67.1% of cases were done under local anesthetic and/or sedation with transfemoral access in 94.7% and transaortic in 5.3%. Three device sizes were used: 23 mm (n = 66, 28.9%), 25 mm (n = 39, 17.1%), and 27 mm (n = 123, 53.9%). The valve was successfully deployed in 99.1% of procedures. After implantation, the mean aortic gradient was 11.4 ± 5.4 mm Hg and aortic valve area 1.6 ± 0.5 cm(2). In-hospital mortality was 1.8% (n = 4). Complications included cardiac tamponade (1.8%), conversion to sternotomy (1.3%), stroke (3.9%), vascular access-related (7.0%), and acute kidney injury (7.9%). The incidence of moderate/severe aortic regurgitation was 0.8% (n = 2). A total of 31.8% of patients required new permanent pacemaker implantation.

CONCLUSIONS:

This analysis represents the largest published series on use of the LOTUS valve. Outcomes using this valve are excellent. In-hospital mortality is very low. Complication rates are low, and the LOTUS valve improves on first-generation valves, particularly with regard to residual aortic regurgitation.

• Authors: Rajiv Rampat, M Zeeshan Khawaja, Jonathan Byrne, Philip MacCarthy, Daniel J Blackman, Arvindra Krishnamurthy, Ashan Gunarathne, Jan Kovac, Adrian Banning, Raj Kharbanda, Sami Firoozi, Stephen Brecker, Simon Redwood, Vinayak Bapat, Michael Mullen, Suneil Aggarwal, Ganesh Manoharan, Mark S Spence, Saib Khogali, Maureen Dooley, James Cockburn, Adam de Belder, Uday Trivedi, David Hildick-Smith
• Journal: JACC. Cardiovascular interventions (JACC Cardiovasc Interv) Vol. 9 Issue 4 Pg. 367-372 (Feb 22 2016) ISSN: 1876-7605 [Electronic] United States
• PMID: 26892082 (Publication Type: Journal Article, Multicenter Study)
• Copyright: Copyright © 2016 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

Topics

• Aged
• Aged, 80 and over
• Aortic Valve (physiopathology)
• Aortic Valve Insufficiency (etiology)
• Aortic Valve Stenosis (diagnosis, mortality, physiopathology, therapy)
• Arrhythmias, Cardiac (etiology, therapy)
• Cardiac Catheterization (adverse effects, instrumentation, mortality)
• Cardiac Pacing, Artificial
• Catheterization, Peripheral (methods)
• Female
• Femoral Artery
• Heart Valve Prosthesis
• Heart Valve Prosthesis Implantation (adverse effects, instrumentation, mortality)
• Hemodynamics
• Hospital Mortality
• Humans
• Male
• Prosthesis Design
• Retrospective Studies
• Risk Factors
• Time Factors
• Treatment Outcome
• United Kingdom