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Abstract
To the Editor,
Transcatheter aortic valve implantation (TAVI) is an alternative therapy to surgical
aortic valve replacement (AVR) in inoperable patients with severe aortic stenosis
(AS). Currently, new valve systems are being developed, and we experienced TAVI with
the Boston Scientific Lotus Valve System (Marlborough, Massachusetts, USA) with two
patients for the first cases in Asia-Pacific countries and Turkey. The first patient
was a 77-year-old woman with severe AS with an echocardiographic aortic valve area
of 0.8 cm2 and a mean aortic pressure gradient of 52 mm Hg, and her left ventricular
function (LVEF) was 35%. Her logistic EuroSCORE was 38%, and she had New York Heart
Association (NYHA) functional class III dyspnea. The other patient was a 82-year-old
woman with severe AS; in her echocardiographic examination, the aortic valve area
was 0.6 cm2, and the mean aortic pressure gradient was 62 mm Hg, with an LVEF of 52%.
Her logistic EuroSCORE was 29%, and she had NYHA class III dyspnea. The Lotus valve
system has some advantages, such as it does not require rapid pacing during valve
system implantation and balloon pre-dilatation, and it has a specific pre-shaped guidewire
that has two types varying the length and curve, designed according to the size of
the left ventricular cavity diameter. This valve system supports an ability to change
positions while opening the valve system at the aortic valve level. Likely, if the
chosen aortic valve size and aortic roof size do not match, the valve system could
be taken back through the sheath. The other important feature of the Lotus valve is
success in the prevention of paravalvular leak (PVL), which is related with increased
mortality rate (1). In the REPRİSE I trial, in which the safety and efficacy of the
Lotus valve were studied, one patient had stroke, PVL was seen in 3 of 11 patients,
and permanent pacemaker implantation was required due to complete heart block, left
bundle branch block, or atrial fibrillation with slow ventricular rate in 4 of 11
patients, while the requirement of permanent pacemaker implantation varies between
3% and 40% with other valve systems (1, 2).
In our patients, the follow-up echocardiography showed a well-functioning prosthesis,
with a mean gradient of 7 mm Hg and 9 mm Hg, respectively. There was no paravalvular
leak or pacemaker implantation required in either patient. The patients were clinically
stable at 30 days of follow-up after the procedure. In summary, the ability to change
valve position to obtain optimal implantation placement and the decrease in PVL rate
are the most important reasons for using the Lotus valve system.
[1]Department of Cardiology, İstanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery
Training and Research Hospital; İstanbul-
Turkey
Author notes
Address for Correspondence: Dr. Derya Öztürk, Mehmet Akif Ersoy Eğitim ve Araştırma Hastanesi, Göğüs Kalp ve
Damar Cerrahisi Kardiyoloji Kliniği, İstasyon Mah. Turgut Özal Bulvarı No:11 Küçükçekmece,
34303, İstanbul-
Türkiye Phone: +90 212 692 20 00 Fax: +90 212 471 94 94 E-mail:
dr.deryaerbas@
123456hotmail.com