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Boston Scientific Program for Transcatheter Aortic Valve Implantation

  • Mohammad AbdelghaniEmail author
  • Mohamed Abdel-Wahab
Chapter

Abstract

The Lotus transcatheter heart valve has unique mechanisms of expansion and paravalvular sealing. It was the first commercially available completely repositionable transcatheter aortic valve and has shown an exceedingly low rate of paravalvular leakage but a high rate of conduction abnormalities and pacemaker implantation. Successive improvements have been introduced to the Lotus valve prototype, and further improvements are currently underway. The ACURATE neo transfemoral valve system is a self-expanding device that has gained rapid popularity given its ease of use, favorable hemodynamic performance, and promising initial clinical results. In this chapter, transfemoral transcatheter aortic valve implantation (TAVI) with the Lotus and ACURATE neo valve systems will be discussed.

Keywords

Transcatheter aortic valve Transfemoral Self-expanding Mechanically-expanding Reposition Paravalvular Regurgitation Hemodynamic Pacemaker Delivery 

Supplementary material

Video 21.1

In vitro deployment of the Lotus valve shown under fluoroscopy. Manipulation of the Lotus deployment Controller is displayed in the right lower panel. Early prosthetic valve function (displayed by a borescope in the left lower panel) secures hemodynamic stability during valve deployment. Video provided courtesy of Boston Scientific Corporation (WMV 19943 kb)

Video 21.2

Unsheathing/resheathing of the Lotus valve. Video provided courtesy of Boston Scientific Corporation (WMV 18677 kb)

Video 21.3a

A patient with a saber-toothed LVOT calcification undergoing TAVI with Edwards Sapien XT valve. Video provided courtesy of Boston Scientific Corporation (AVI 50697 kb)

Video 21.3b

The same patient in Video 21.3a, with final post-implantation aortography showing severe paravalvular leakage that required conversion to surgery. Video provided courtesy of Boston Scientific Corporation (AVI 13829 kb)

Video 21.3c

Another patient with a saber-toothed LVOT calcification received a Lotus valve, which showed a high-grade regurgitation on first implantation attempt. Video provided courtesy of Boston Scientific Corporation (AVI 20998 kb)

Video 21.3d

The same patient in Video 21.3c, where repositioning led to amelioration of regurgitation. Video provided courtesy of Boston Scientific Corporation (AVI 20742 kb)

Video 21.3e

The same patient in Videos 21.3c and 21.3d, with only mild regurgitation after final deployment. Video provided courtesy of Boston Scientific Corporation (AVI 23814 kb)

Video 21.4a

Deployment of the ACURATE neo™ transfemoral aortic valve. The stabilizing arches are deployed first. Video provided courtesy of Boston Scientific Corporation (MOV 1099 kb)

Video 21.4b

Further steps of deployment of the ACURATE neo™ transfemoral aortic valve (Video 21.4a continued). After the upper crown is released, it is gently pushed until it hooks onto the native annulus and deployment of the inflow (landing) portion of the frame is followed by a final release. Video provided courtesy of Boston Scientific Corporation (MOV 595 kb)

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Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Heart Center, Segeberger KlinikenBad SegebergGermany
  2. 2.Cardiology DepartmentThe Academic Medical Center, University of AmsterdamAmsterdamThe Netherlands

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