Ole De Backer1, Matthias Götberg2, Leo Ihlberg3, Erik Packer4, Mikko Savontaus5, Niels E Nielsen6, Troels H Jørgensen7, Antti Nykänen3, Jacek Baranowski6, Matti Niemelä8, Markku Eskola9, Henrik Bjursten2, Lars Søndergaard7. 1. The Heart Center, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark. Electronic address: ole.debacker@gmail.com. 2. Department of Cardiology, Skåne University Hospital, Lund, Sweden. 3. Heart and Lung Center, Helsinki University Hospital, Helsinki, Finland. 4. Department of Cardiology, Haukeland University Hospital, Bergen, Norway. 5. Heart Center, Turku University Hospital, Turku, Finland. 6. Heart Center, Linköping University Hospital, Linköping, Sweden. 7. The Heart Center, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark. 8. Department of Cardiology, Oulu University Hospital, Oulu, Finland. 9. Department of Cardiology, Tampere University Hospital, Tampere, Finland.
Abstract
BACKGROUND: Transcatheter aortic valve replacement (TAVR) has become an established therapeutic option for patients with symptomatic, severe aortic valve stenosis (AS) who are ineligible or at high risk for conventional valvular surgery. In Northwestern Europe, the TAVR technology is also increasingly used to treat patients with an intermediate risk profile. METHODS AND RESULTS: The study was designed as an independent Nordic multicenter registry of intermediate risk patients treated with the Lotus Valve System (Boston Scientific, MA, USA; N=154). Valve Academic Research Consortium (VARC)-defined device success was obtained in 97.4%. A Lotus Valve was successfully implanted in all patients. There was no valve migration, embolization, ectopic valve deployment, or TAV-in-TAV deployment. The VARC-defined combined safety rate at 30days was 92.2%, with a mortality rate of 1.9% and stroke rate of 3.2%. The clinical efficacy rate after 30days was 91.6% - only one patient had moderate aortic regurgitation. When considering only those patients in the late experience group (N=79), the combined safety and clinical efficacy rates were 93.7% and 92.4%, respectively. The pacemaker implantation rate was 27.9% - this rate was 12.8% in case of a combined implantation depth <4mm and a device/annulus ratio<1.05. CONCLUSIONS: The present study demonstrates the efficacy and safety of the repositionable, retrievable Lotus Valve System in intermediate risk patients with AS. The VARC-defined device success rate was 97.4% with a 30-day patient safety and clinical efficacy rate of more than 90%. Less than moderate aortic regurgitation was obtained in 99.4% of patients.
BACKGROUND: Transcatheter aortic valve replacement (TAVR) has become an established therapeutic option for patients with symptomatic, severe aortic valve stenosis (AS) who are ineligible or at high risk for conventional valvular surgery. In Northwestern Europe, the TAVR technology is also increasingly used to treat patients with an intermediate risk profile. METHODS AND RESULTS: The study was designed as an independent Nordic multicenter registry of intermediate risk patients treated with the Lotus Valve System (Boston Scientific, MA, USA; N=154). Valve Academic Research Consortium (VARC)-defined device success was obtained in 97.4%. A Lotus Valve was successfully implanted in all patients. There was no valve migration, embolization, ectopic valve deployment, or TAV-in-TAV deployment. The VARC-defined combined safety rate at 30days was 92.2%, with a mortality rate of 1.9% and stroke rate of 3.2%. The clinical efficacy rate after 30days was 91.6% - only one patient had moderate aortic regurgitation. When considering only those patients in the late experience group (N=79), the combined safety and clinical efficacy rates were 93.7% and 92.4%, respectively. The pacemaker implantation rate was 27.9% - this rate was 12.8% in case of a combined implantation depth <4mm and a device/annulus ratio<1.05. CONCLUSIONS: The present study demonstrates the efficacy and safety of the repositionable, retrievable Lotus Valve System in intermediate risk patients with AS. The VARC-defined device success rate was 97.4% with a 30-day patient safety and clinical efficacy rate of more than 90%. Less than moderate aortic regurgitation was obtained in 99.4% of patients.
Authors: Q Xu; X Liu; J Jiang; Y He; Q Zhu; F Gao; F Du; W He; J Cheng; M Kong; Z Pu; Q Zhou; R Gooley; J Wang Journal: Herz Date: 2019-01-29 Impact factor: 1.443