Transfemoral Transcatheter Aortic Valve-in-Valve Implantation for Aortic Valve Bioprosthesis Failure With the Fully Repositionable and Retrievable Lotus Valve: A Single-Center Experience.
Ruparelia N., Thomas K., Newton JD., Grebenik K., Keiralla A., Krasopoulos G., Sayeed R., Banning AP., Kharbanda RK.
OBJECTIVE: To report a first case series of the Lotus valve (Boston Scientific) for the treatment of surgical aortic bioprosthesis failure. BACKGROUND: Valve-in-valve (VIV) transcatheter aortic valve implantation (TAVI) is an established management option for surgical aortic bioprosthesis failure. Although TAVI has proven efficacious, complications relating to suboptimal valve implantation have been reported in approximately 5% of patients. The Lotus valve is fully repositionable and retrievable, and therefore enables complete assessment of valve function prior to definitive deployment. However, data supporting its use for this indication are limited. METHODS: Consecutive patients who underwent transfemoral VIV-TAVI at John Radcliffe Hospital between January 2015 and December 2016 were retrospectively analyzed. Procedural and 30-day outcomes were reported in accordance with Valve Academic Research Consortium-2 (VARC-2) definitions. RESULTS: Seven patients underwent VIV-TAVI with the Lotus valve. Device success according to VARC-2 criteria was achieved in 6 of the 7 patients. Following implantation, transvalvular hemodynamics were acceptable, with a mean gradient of 11.9 ± 6.6 mm Hg. All patients had mild or no residual aortic regurgitation. Specifically, no patient required further valve-related intervention, or suffered myocardial infarction, stroke, or acute kidney injury stage 2 or 3. There were no deaths during the follow-up period. CONCLUSIONS: Transfemoral VIV-TAVI for the treatment of surgical aortic bioprosthesis failure with the Lotus device appears to be safe and is associated with no significant residual aortic regurgitation, and offers favorable transvalvular hemodynamics at 30-day follow-up.