Transcatheter Aortic Valve Implantation with Lotus^TM Valve

- Operator : Seung-Jung Park

Transcatheter Aortic Valve Implantation with LotusTM Valve

- Operator: Seung-Jung Park, MD

Case Presentation

A 79 year-old male patient was admitted for the treatment of recently developed dyspnea on exertion (NYHA III). He had a past medical history of hypertension and diabetes, and had been recently hospitalized due to traumatic SDH. Diagnosed as severe AS, we planned to perform TAVI for this patient. His logistic EuroSCORE and STS score was 4.83% and 2.405%, respectively.

Echocardiographic Findings

Transthoracic echocardiography showed severe degenerative AS with normal LV function (LVEF 63%). AV area by continuity equation was 0.57 cm². Transaortic peak velocity and mean pressure gradient was 4.8 m/s and 61mmHg, respectively.

CT Findings

Annulus size by CT was 22.3×24.4 mm and the perimeter was 77.3 mm (Figure 1). Distance from annulus to LCA and RCA ostium was 14.2 and 17.1 mm, respectively (Figure 2). The minimal diameter of left ileofemoral artery was 7.2 mm and there was no problem in the vessel size and the degree of calcification.

Procedure

Considering the annulus size by CT, the 25 mm LotusTM valve (Boston Scientific) was selected for implantation. Under general anesthesia, the 6 Fr sheath and temporary pacemaker were inserted through left femoral vein, and the 7 Fr sheath and 6 Fr pig-tail catheter were inserted through left femoral artery. After the right peripheral angiogram with the pig-tail catheter, we selected a proper puncture site of right femoral artery. A 8 Fr sheath was inserted through the right femoral artery, and then two 8 Fr Proglide devices were placed into the right femoral artery. After removal of the sheath, 21 Fr Boston-sheath was inserted. An AL 1 diagnostic catheter with a 0.035-inch stiff wire was used to cross the aortic valve. After crossing the valve, the stiff wire was replaced by a 0.035-inch Lunderquist super-stiff wire. Under fluoroscopy control, a 25-mm LotusTM prosthesis crimped on the delivery catheter was placed at the level of the aortic annulus. The control knob of the delivery handle was carefully turned to deploy the valve. Ensuring the precise placement of the prosthesis under the guidance of the radiopaque marker and the compressed form of the struts by the calcified native valves ( Movie 1), the control knob was further turned to proceed the locking process ( Movie 2, Movie 3). After identifying that the configuration of the locking system was appropriate using multiple angiographic views ( Movie 4), the valve was finally released. The final fluoroscopy showed well positioned LotusTM valve without significant paravalvular leakage ( Movie 5, Movie 6). The 21 Fr Boston-sheath was removed after checking the right peripheral angiogram. The puncture site was sutured by the prepared two Proglide devices.