Author + information
- Received August 11, 2014
- Revision received September 17, 2014
- Accepted October 8, 2014
- Published online February 1, 2015.
- Nicolas M. Van Mieghem, MD, PhD∗∗ (, )
- Ramon Rodriguez-Olivares, MD∗,
- Ben Ren, MD∗,
- Mohamed Ouhlous, MD, PhD†,
- Tjebbe W. Galema, MD, PhD∗,
- Marcel L. Geleijnse, MD, PhD∗,
- Arie-Pieter Kappetein, MD, PhD‡ and
- Peter P. de Jaegere, MD, PhD∗
- ∗Department of Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, the Netherlands
- †Department of Radiology, Erasmus Medical Center, Rotterdam, the Netherlands
- ‡Department of Cardio-Thoracic Surgery, Erasmus Medical Center, Rotterdam, the Netherlands
- ↵∗Reprint requests and correspondence:
Dr. Nicolas M. Van Mieghem, Department of Interventional Cardiology, Thoraxcenter, Erasmus Medical Center, Room Bd 171, ‘s Gravendijkwal 230, 3015 CE Rotterdam, the Netherlands.
A 79-year-old man with prior surgical aortic valve replacement was admitted with acute heart failure. Diagnostic work up revealed a degenerated 25-mm Carpentier-Edwards aortic bioprosthesis with severe stenosis. The calculated Society of Thoracic Surgery predicted risk of mortality was 21.9%. The multidisciplinary heart team reached consensus for transcatheter valve replacement in the failing aortic bioprosthesis. The Lotus valve (Boston Scientific, Natick, Massachusetts) allows for a controlled mechanical deployment and is completely repositionable and retrievable even after full expansion (1). The 25-mm Carpentier-Edwards bioprosthesis has a true inner diameter—encompassing the leaflet tissue mounted within the stent—of 21 mm and therefore should accommodate a 23-mm Lotus transcatheter heart valve (2). Because of mild-to-moderate paravalvular aortic regurgitation (AR) after the initial implant, the Lotus valve was repositioned 2 mm more aortic, improving coaxial alignment and sealing. Mean transvalvular gradient was 11 mm Hg with only trivial paravalvular AR (Figure 1). Transcatheter aortic valve replacement is a valuable treatment strategy for patients with a failing aortic bioprosthesis although residual paraprosthetic regurgitation, and higher transvalvular gradients may limit overall success (3). This report illustrates the proof of concept of the intrinsic repositionable/retrievable features of the Lotus valve in a degenerated aortic bioprosthesis.
Dr. Van Mieghem has received consulting fees and research grants from Abbott Vascular, Boston Scientific, Edwards Lifesciences, Medtronic, and Claret Medical. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received August 11, 2014.
- Revision received September 17, 2014.
- Accepted October 8, 2014.
- 2015 American College of Cardiology Foundation
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