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

详细信息    查看全文

• 作者：Rajiv Rampat ; MBBS^a ; M. Zeeshan Khawaja ; MBBS^a ; Jonathan Byrne ; MD^b ; Philip MacCarthy ; MD^b ; Daniel J. Blackman ; MD^c ; Arvindra Krishnamurthy ; MD^c ; Ashan Gunarathne ; MD^d ; Jan Kovac ; MD^d ; Adrian Banning ; MD^e ; Raj Kharbanda ; MD^e ; Sami Firoozi ; MD^f ; Stephen Brecker ; MD^f ; Simon Redwood ; MD^g ; Vinayak Bapat ; MD^g ; Michael Mullen ; MD^h ; Suneil Aggarwal ; MD^h ; Ganesh Manoharan ; MDⁱ ; Mark S. Spence ; MDⁱ ; Saib Khogali ; MD^j ; Maureen Dooley ; MBBS^a ; James Cockburn ; MD^a ; Adam de Belder ; MD^a ; Uday Trivedi ; MD^a ; David Hildick-Smith ; MD^a ; ^{david.hildick-smith@bsuh.nhs.uk" class="auth_mail" title="E-mail the corresponding author}
• 关键词：aortic stenosis ; complication ; LOTUS ; outcome ; transcatheter aortic valve
• 刊名：JACC: Cardiovascular Interventions
• 出版年：2016
• 出版时间：22 February 2016
• 年：2016
• 卷：9
• 期：4
• 页码：367-372
• 全文大小：258 K

文摘

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 cm². 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.