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Transcatheter Aortic Valve Implantation: Boston Lotus

  • Lennart van Gils
  • Nicolas M. Van Mieghem
Chapter

Abstract

The Lotus valve system (Boston Scientific, Marlborough, MA, USA) consists of a trileaflet bovine pericardial valve supported on a braided nitinol frame (Fig. 22.1). A central radiopaque marker facilitates positioning of the prosthesis within the aortic root. The frame is covered with an Adaptive Seal at the inflow segment that adapts to aortic root irregularities and minimizes paravalvular leak (Fig. 22.2). This transcatheter heart valve is currently available in three sizes—23, 25, and 27 mm (Fig. 22.3)—covering a range of annulus diameters from 19 to 27 mm. In fully deployed state, all sizes have a frame height of 19 mm. The 23 mm model can be delivered through an 18 Fr sheath (small), while the 25 and 27 mm valves require a 20 Fr (large) sheath. Lotus is typically inserted with a transfemoral approach, though direct aortic and trans-axillary alternative access is possible. Implantation of a Lotus valve requires the following components:
  • A support guidewire: either a manually curved Super/Extra Stiff 0.035″ guidewire (260 cm for 23 mm and 275 for 25 and 27 mm) or a pre-shaped Safari2 guidewire with an extra-small, small, or large curve (Fig. 22.4).

  • Lotus introducer—small for 23 mm and large for 25 and 27 mm (Fig. 22.5).

  • Lotus valve delivery system, with pre-mounted Lotus valve—103 cm for 23 and 113 cm for 25 and 27 mm (Fig. 22.6). The pre-shaped angulated delivery system should help negotiate the thoracic aorta.

  • Prostar or double Perclose ProGlide (Abbott Vascular, Abbot Park, Illinois, USA) suture-based closure for transfemoral access (Fig. 22.7).

Copyright information

© Springer International Publishing AG 2018

Authors and Affiliations

  1. 1.Department of Interventional CardiologyThoraxcenter, Erasmus Medical CenterRotterdamNetherlands

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