Page 49 - Journal of Structural Heart Disease Volume 2, Issue 1

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Meeting Abstracts
IMPORTANCE OF CARDIAC CT PRIOR TO A SEC- OND GENERATION TRANSCATHETER AORTIC VALVE IMPLANTATION
Ines Ponz, Daniele Gemma, Elena Refoyo, Emilio Cuesta, Guillermo Galeote, Zorba Blazquez, Juan Caro, Mar Moreno, Raul Moreno, Jose Luis Lopez Sendon
Hospital Universitario La Paz, Madrid, Spain
Introduction: The LotusTM Valve (LV) is a second-generation tran- scatheter aortic prosthetic valve. Our aim was to identify predictors of potential complications related to its implantation.
Methods: Prospective study including patients submitted to LV im- plantation between May 2014 and February 2015. Transthoracic and transesophageal echocardiography and Cardiac Computerized To- mography (CT) was performed before the procedure.
Results: 16 patients underwent LV implantation: number 23 in 56.2%, 25 in 18.8% and 27 in 25% (62.5% female, mean age 80.5 years, mean EuroSCORE 9.65, Table1). After the procedure both mean and maxi- mal gradient improved in all patients (p0.001), nding no predictors of such improvement.
We found a higher incidence of postprocedural complications among patients with a greater ascending aortic diameter by CT (37.9 vs. 32.6mm, p0.011), and with left ventricular dysfunction, particularly with renal failure (p0.001).
Pacemaker implantation (50%) was associated with a greater left ven- tricular out ow tract (LVOT) perimeter (73.6 vs. 65.2mm, p0.03) and calci cation of the mitroaortic brosa (p0.001), which was also more frequent among patients developing bundel branch block (62.5%; p0.035).
12.5% su ered a cardiac arrest due to atrioventricular block, which was associated with a greater LVOT area (484 vs. 343mm2, p0.005) and perimeter (82 vs. 68.2mm, p0.002), measured by CT, and also with implantation of a bigger valve (p0.02).
Conclusion: Performing a Cardiac CT prior to a LV implant is useful to predict possible postprocedural complications. A greater LVOT with implantation of a bigger valve and the calci cation of the mitroaortic brosa associate a greater risk of conduction disorders.
Table 1: Echocardiographic or tomographic/radiographic characteristics
LOTUS, A NEWSECOND-GENERATION TRANSCATHETER AORTIC PROSTHETIC VALVE EFFICACY AND SAFETY Daniele Gemma, Inés Ponz De Antonio, Raúl Moreno Gómez, Guillermo Galeote García, Elena Refoyo Salicio, José Luis López Sendón
Hospital Universitario La Paz, Madrid, Spain
Background: LotusTM Valve (LV) is a second-generation transcath- eter aortic prosthetic valve (TAVI), retrievable and repositionable, designed to minimize the risk of complications, particularly peripros- thetic aortic regurgitation (AR). Experience with this new TAVI is still limited.
Objective: The aim of our study is to report the results of our initial experience with LV implantation, in terms of safety and e cacy.
Materials: Prospective study including patients with severe aortic stenosis who underwent LV implantation in our centre between May 2014 and February 2015. We report echocardiographic and clinical outcomes until hospital discharge.
Results: 16 patients underwent LV implantation (62.5% female, mean age 80.5 years, mean EuroSCORE 9.65). During the procedure, a pa- tient su ered a thrombotic occlusion of the left main coronary artery, which was corrected by thromboaspiration, without sequelae. No prosthesis embolization was observed. Following LV implantation, both mean and maximal gradient and AR improved in all patients (p0.001), with no cases of periprosthetic AR post TAVI. Pulmonary sys- tolic pressure was reduced in 50% of patients (see Table 1). 8 patients su ered complete atrioventricular block until eight days after the procedure, requiring pacemaker implantation. The average hospital stay was 5 days, without any exitus at discharge.
Conclusion: Lotus is an e ective and safe alternative for the treat- ment of patients with severe aortic stenosis and high surgical risk, despite a relatively high incidence of conduction disorders in our ini- tial experience. Studies are needed to better patient selection for this type of TAVI.
Pre-Lotus
Post-Lotus
P
Mean value
Valvular área (3D planimtry)
Pre-procedure maximal gradient Pre-procedure mean gradient LVEF
Aortic annulus area (CT)
Aortic annulus perimeter (CT) Calcium Score
0,65 cm2
65,2 mmHg 20,3 mmHg 62,3% 442,4 mm2 78,9 mm 3048,6
Table 1: Pulmonary Systolic Pressure Maximal Gradient 65,2 mmHg
Mean Gradient 4 20,3 mmHg
Aortic 68,8% grade I or II regurgitation
Pulmonary Artery 51 mmHg Systolic Pressure
20,2 mmHg 10,1 mmHg 18% grade I
39,9 mmHg
p 0,001 p 0,001 p 0,001
p 0,01
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