title: Transcatheter Aortic Valve Replacement Using the Repositionable LOTUS Valve: United Kingdom Experience.
abstract: OBJECTIVE
  This study sought to present the U.K. experience to date with the second-generation LOTUS bioprosthesis (Boston Scientific, Natick, Massachusetts).
  
  
  BACKGROUND
  First-generation transcatheter aortic valves have limitations. Second-generation repositionable valves may improve on some of those limitations.
  
  
  METHODS
  Prospectively collected data relating to procedural and in-hospital outcome was analyzed from 10 implantation centers in the United Kingdom.
  
  
  RESULTS
  Implants in 228 patients age 81.4 ± 7.6 years were studied; 53.5% were male. Mean logistic EuroScore was 17.5 ± 12.4. One hundred eighty-seven (82.0%) were undertaken for aortic stenosis, 7 (3.1%) for aortic regurgitation, and 34 (14.9%) for mixed aortic valve disease. A total of 67.1% of cases were done under local anesthetic and/or sedation with transfemoral access in 94.7% and transaortic in 5.3%. Three device sizes were used: 23 mm (n = 66, 28.9%), 25 mm (n = 39, 17.1%), and 27 mm (n = 123, 53.9%). The valve was successfully deployed in 99.1% of procedures. After implantation, the mean aortic gradient was 11.4 ± 5.4 mm Hg and aortic valve area 1.6 ± 0.5 cm(2). In-hospital mortality was 1.8% (n = 4). Complications included cardiac tamponade (1.8%), conversion to sternotomy (1.3%), stroke (3.9%), vascular access-related (7.0%), and acute kidney injury (7.9%). The incidence of moderate/severe aortic regurgitation was 0.8% (n = 2). A total of 31.8% of patients required new permanent pacemaker implantation.
  
  
  CONCLUSIONS
  This analysis represents the largest published series on use of the LOTUS valve. Outcomes using this valve are excellent. In-hospital mortality is very low. Complication rates are low, and the LOTUS valve improves on first-generation valves, particularly with regard to residual aortic regurgitation.
authors.affiliation: Sussex Cardiac Centre, Brighton and Sussex University Hospitals, Brighton, United Kingdom.
authors.forename: Rajiv
authors.initials: R
authors.lastname: Rampat
authors.affiliation: Sussex Cardiac Centre, Brighton and Sussex University Hospitals, Brighton, United Kingdom.
authors.forename: M Zeeshan
authors.initials: MZ
authors.lastname: Khawaja
authors.affiliation: Cardiology Department, Kings College Hospital, London, United Kingdom.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Byrne
authors.affiliation: Cardiology Department, Kings College Hospital, London, United Kingdom.
authors.forename: Philip
authors.initials: P
authors.lastname: MacCarthy
authors.affiliation: Cardiology Department, Leeds Teaching Hospitals, Leeds, United Kingdom.
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Blackman
authors.affiliation: Cardiology Department, Leeds Teaching Hospitals, Leeds, United Kingdom.
authors.forename: Arvindra
authors.initials: A
authors.lastname: Krishnamurthy
authors.affiliation: Cardiology Department, University Hospitals of Leicester, Leicester, United Kingdom.
authors.forename: Ashan
authors.initials: A
authors.lastname: Gunarathne
authors.affiliation: Cardiology Department, University Hospitals of Leicester, Leicester, United Kingdom.
authors.forename: Jan
authors.initials: J
authors.lastname: Kovac
authors.affiliation: Cardiology Department, Oxford University Hospitals, Oxford, United Kingdom.
authors.forename: Adrian
authors.initials: A
authors.lastname: Banning
authors.affiliation: Cardiology Department, Oxford University Hospitals, Oxford, United Kingdom.
authors.forename: Raj
authors.initials: R
authors.lastname: Kharbanda
authors.affiliation: Cardiology Department, St. George's Hospital, London, United Kingdom.
authors.forename: Sami
authors.initials: S
authors.lastname: Firoozi
authors.affiliation: Cardiology Department, St. George's Hospital, London, United Kingdom.
authors.forename: Stephen
authors.initials: S
authors.lastname: Brecker
authors.affiliation: Cardiovascular Centre, Guy's and St. Thomas's Hospitals, London, United Kingdom.
authors.forename: Simon
authors.initials: S
authors.lastname: Redwood
authors.affiliation: Cardiovascular Centre, Guy's and St. Thomas's Hospitals, London, United Kingdom.
authors.forename: Vinayak
authors.initials: V
authors.lastname: Bapat
authors.affiliation: Barts Heart Centre, St Bartholomew's Hospital, London, United Kingdom.
authors.forename: Michael
authors.initials: M
authors.lastname: Mullen
authors.affiliation: Barts Heart Centre, St Bartholomew's Hospital, London, United Kingdom.
authors.forename: Suneil
authors.initials: S
authors.lastname: Aggarwal
authors.affiliation: Cardiology Department, Royal Victoria Hospital, Belfast, United Kingdom.
authors.forename: Ganesh
authors.initials: G
authors.lastname: Manoharan
authors.affiliation: Cardiology Department, Royal Victoria Hospital, Belfast, United Kingdom.
authors.forename: Mark S
authors.initials: MS
authors.lastname: Spence
authors.affiliation: Cardiology Department, Royal Wolverhampton Hospital, Wolverhampton, United Kingdom.
authors.forename: Saib
authors.initials: S
authors.lastname: Khogali
authors.affiliation: Sussex Cardiac Centre, Brighton and Sussex University Hospitals, Brighton, United Kingdom.
authors.forename: Maureen
authors.initials: M
authors.lastname: Dooley
authors.affiliation: Sussex Cardiac Centre, Brighton and Sussex University Hospitals, Brighton, United Kingdom.
authors.forename: James
authors.initials: J
authors.lastname: Cockburn
authors.affiliation: Sussex Cardiac Centre, Brighton and Sussex University Hospitals, Brighton, United Kingdom.
authors.forename: Adam
authors.initials: A
authors.lastname: de Belder
authors.affiliation: Sussex Cardiac Centre, Brighton and Sussex University Hospitals, Brighton, United Kingdom.
authors.forename: Uday
authors.initials: U
authors.lastname: Trivedi
authors.affiliation: Sussex Cardiac Centre, Brighton and Sussex University Hospitals, Brighton, United Kingdom. Electronic address: david.hildick-smith@bsuh.nhs.uk.
authors.forename: David
authors.initials: D
authors.lastname: Hildick-Smith
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000503:physiopathology; D001022:Aortic Valve Insufficiency / Q000209:etiology; D001024:Aortic Valve Stenosis / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D001145:Arrhythmias, Cardiac / Q000209:etiology / Q000628:therapy; D006328:Cardiac Catheterization / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality; D002304:Cardiac Pacing, Artificial; D002406:Catheterization, Peripheral / Q000379:methods*; D005260:Female; D005263:Femoral Artery; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality; D006439:Hemodynamics; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D011474:Prosthesis Design; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D006113:United Kingdom
keywords: LOTUS; aortic stenosis; complication; outcome; transcatheter aortic valve