Cardiovascular magnetic resonance assessment of 1st generation CoreValve and 2nd generation Lotus valves

Musa, Tarique Al, Uddin, Akhlaque, Dobson, Laura E., Swoboda, Peter P., Garg, Pankaj ORCID: https://orcid.org/0000-0002-5483-169X, Foley, James R. J., Malkin, Christopher, Plein, Sven, Blackman, Daniel J. and Greenwood, John P. (2018) Cardiovascular magnetic resonance assessment of 1st generation CoreValve and 2nd generation Lotus valves. Journal of Interventional Cardiology, 31 (3). pp. 391-399. ISSN 0896-4327

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Abstract

Objectives: We sought to compare using serial CMR, the quantity of AR and associated valve hemodynamics, following the first-generation CoreValve (Medtronic, Minneapolis, MN) and the second-generation Lotus valve (Boston Scientific, Natick, MA). Background: Aortic regurgitation (AR) following Transcatheter Aortic Valve Replacement (TAVR) confers a worse prognosis and can be accurately quantified using cardiovascular magnetic resonance (CMR). Second generation valves have been specifically designed to reduce paravalvular AR and improve clinical outcomes. Methods: Fifty-one patients (79.0 ± 7.7 years, 57% male) were recruited and imaged at three time points: immediately pre- and post-TAVR, and at 6 months. Results: CMR-derived AR fraction immediately post-TAVR was greater in the CoreValve compared to Lotus group (11.7 ± 8.4 vs. 4.3 ± 3.4%, P = 0.001), as was the frequency of ≥moderate AR (9/24 (37.5%) versus 0/27, P < 0.001). However, at 6 months AR fraction had improved significantly in the CoreValve group such that the two valve designs were comparable (6.4 ± 5.0 vs 5.6 ± 5.3%, P = 0.623), with no patient in either group having ≥moderate AR. The residual peak pressure gradient immediately following TAVR was significantly lower with CoreValve compared to Lotus (14.1 ± 5.6 vs 25.4 ± 11.6 mmHg, P = 0.001), but again by 6 months the two valve designs were comparable (16.5 ± 9.4 vs 19.7 ± 10.5 mmHg, P = 0.332). There was no difference in the degree of LV reverse remodeling between the two valves at 6 months. Conclusion: Immediately post-TAVR, there was significantly less AR but a higher residual peak pressure gradient with the Lotus valve compared to CoreValve. However, at 6 months both devices had comparable valve hemodynamics and LV reverse remodeling.

Item Type:	Article
Faculty \ School:	Faculty of Medicine and Health Sciences > Norwich Medical School
UEA Research Groups:	Faculty of Medicine and Health Sciences > Research Centres > Metabolic Health
Depositing User:	LivePure Connector
Date Deposited:	20 Nov 2021 01:40
Last Modified:	19 Oct 2023 03:10
URI:	https://ueaeprints.uea.ac.uk/id/eprint/82255
DOI:	10.1111/joic.12512

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