First North American experience with the transfemoral ACURATE‐neo^TM self‐expanding transcatheter aortic bioprosthesis

Abstract

The present initial North American experience shows that the ACURATE-neo aortic bioprosthesis was safely and successfully implanted by transfemoral approach. The special design of this newer-generation device affords a stable and predictable implantation, while providing optimal hemodynamic performance with a relatively low rate of PPI. © 2016 Wiley Periodicals, Inc.

Transcatheter aortic valve implantation with the repositionable and fully retrievable Lotus Valve SystemTM

“…Importantly, PVL was absent or trace in 92% of patients, 7.7% of patients showed mild PVL, 0.3% of patients moderate PVL and none presented with severe PVL. The Lotus Valve TM device seals the aortic annulus adjusting to the patient's anatomy with the mechanically expandable frame, and these results are equivalent or compare favorably to recent reports using different second-generation TAV devices (6,8,9,13,14). (15) showed that the independent predictors of mild/moderate PVL included the ratio of device area to annulus area, left ventricular outflow tract (LVOT) calcium volume, and annulus area.…”

“…Recent recommendations found that transfemoral TAVI, in comparison to SAVR, results in lower mortality and acute kidney injury at 2 years, and may reduce stroke rates (5). Over the past 15 years, several transcatheter devices have been tested and evolved to decrease access site complications with smaller profile delivery systems, decrease pacemaker rates, and avoid the risk of coronary obstruction and significant paravalvular leakage (PVL) (6)(7)(8)(9).…”

Transfemoral transcatheter ACURATE-neo ™ aortic valve replacement in a patient with a previous mechanical mitral valve

“…A coronary height less than 12 mm is a predictor for coronary obstruction, especially in narrow or porcelain aortic roots . The ACURATE‐ neo ™ is designed for infra‐coronary placement; the stabilization‐arches are opened in the ascending aorta while the upper‐crown and waist capture the native aortic leaflets toward the aortic annulus, consequently diminishing the risk for coronary ostia obstruction …”

“…The ACURATE‐ neo ™ with its ACURATE‐TF™ delivery system is well designed for horizontal aortic roots, an anatomical feature that has been traditionally considered a challenge for transfemoral TAVR procedures. Unlike other self‐expanding devices, the ACURATE‐ neo ™ is released from the aorta, following the “top‐to‐down” concept, rather than from the LVOT . Notably, the “V‐shape” of the device with the upper‐crown and stabilizers opened (Fig.…”

“…C and ). Although not usually required for this device deployment, we used rapid pacing to minimize the risk of valve embolization because of frequent premature ventricular complexes that were present. Aortic root angiography was performed immediately after valve deployment and confirmed that the coronary arteries were patent.…”