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J Am Coll Cardiol. 2014 Sep 30;64(13):1339-48. doi: 10.1016/j.jacc.2014.05.067.

Transcatheter aortic valve replacement for severe symptomatic aortic stenosis using a repositionable valve system: 30-day primary endpoint results from the REPRISE II study.

Author information

1
MonashHEART, Monash Health, and Monash University, Clayton, Victoria, Australia. Electronic address: ian.meredith@myheart.id.au.
2
The Prince Charles Hospital and University of Queensland, Brisbane, Queensland, Australia.
3
Pôle Cardiovasculaire et Métabolique, Centre Hospitalier Universitaire Rangueil, Toulouse, France.
4
Royal Adelaide Hospital, Adelaide, South Australia, Australia.
5
Clinique Pasteur, Toulouse, France.
6
Royal Victoria Hospital, Belfast, United Kingdom.
7
Leeds General Infirmary, Leeds, United Kingdom.
8
Hôpital Cardiologique, Hospices Civils de Lyon, Lyon, France.
9
Sussex Cardiac Centre, Brighton and Sussex University Hospitals, Brighton, United Kingdom.
10
St. Vincent's Hospital (Melbourne), Fitzroy, Victoria, Australia.
11
Institut Cardiovasculaire, Paris Sud, Massy, France.
12
Deutsches Herzzentrum München, München, Germany.
13
HELIOS Klinikum Siegburg, Siegburg, Germany.
14
Guys and St. Thomas' NHS Foundation Trust, London, United Kingdom.
15
Boston Scientific Corporation, Marlborough, Massachusetts.

Abstract

BACKGROUND:

Transcatheter aortic valve replacement provides results comparable to those of surgery in patients at high surgical risk, but complications can impact long-term outcomes. The Lotus valve, designed to improve upon earlier devices, is fully repositionable and retrievable, with a unique seal to minimize paravalvular regurgitation (PVR).

OBJECTIVES:

The prospective, single-arm, multicenter REPRISE II study (REpositionable Percutaneous Replacement of Stenotic Aortic Valve Through Implantation of Lotus Valve System: Evaluation of Safety and Performance) evaluated the transcatheter valve system for treatment of severe symptomatic calcific aortic valve stenosis.

METHODS:

Patients (n = 120; aortic annulus 19 to 27 mm) considered by a multidisciplinary heart team to be at high surgical risk received the valve transfemorally. The primary device performance endpoint, 30-day mean pressure gradient, was assessed by an independent echocardiographic core laboratory and compared with a pre-specified performance goal. The primary safety endpoint was 30-day mortality. Secondary endpoints included safety/effectiveness metrics per Valve Academic Research Consortium criteria.

RESULTS:

Mean age was 84.4 years, 57% of the patients were female, and 76% were New York Heart Association functional class III/IV. Mean aortic valve area was 0.7 ± 0.2 cm(2). The valve was successfully implanted in all patients, with no cases of valve embolization, ectopic valve deployment, or additional valve implantation. All repositioning (n = 26) and retrieval (n = 6) attempts were successful; 34 patients (28.6%) received a permanent pacemaker. The primary device performance endpoint was met, because the mean gradient improved from 46.4 ± 15.0 mm Hg to 11.5 ± 5.2 mm Hg. At 30 days, the mortality rate was 4.2%, and the rate of disabling stroke was 1.7%; 1 (1.0%) patient had moderate PVR, whereas none had severe PVR.

CONCLUSIONS:

REPRISE II demonstrates the safety and effectiveness of the Lotus valve in patients with severe aortic stenosis who are at high surgical risk. The valve could be positioned successfully with minimal PVR. (REPRISE II: REpositionable Percutaneous Replacement of Stenotic Aortic Valve Through Implantation of Lotus™ Valve System - Evaluation of Safety and Performance; NCT01627691).

KEYWORDS:

TAVR; aortic regurgitation; aortic valve stenosis; transfemoral

PMID:
25257635
DOI:
10.1016/j.jacc.2014.05.067
[Indexed for MEDLINE]
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