Safety and efficacy of a repositionable and fully retrievable aortic valve used in routine clinical practice: the RESPOND Study

Eur Heart J. 2017 Dec 1;38(45):3359-3366. doi: 10.1093/eurheartj/ehx297.

Abstract

Aims: RESPOND is a prospective, open-label, single-arm study evaluating the outcomes following transcatheter aortic valve implantation (TAVI) with the repositionable and fully retrievable Lotus Valve used in routine clinical practice for the treatment of patients with aortic valve stenosis.

Methods and results: RESPOND enrolled 1014 patients at sites across Europe, New Zealand, and Latin America; 996 patients received a Lotus Valve (mean age: 80.8 years; 50.8% female; Society of Thoracic Surgeons score: 6.0 ± 6.9). Repositioning was attempted in 29.2% of patients, with 99% success. The rate of all-cause mortality in the intent-to-treat population at 30 days (primary endpoint) was 2.6% (P < 0.001 vs. pre-specified performance goal). Thirty-day clinical follow-up was completed for 97.3% of patients. Among patients who received a Lotus Valve, the 30-day overall and disabling stroke rates were 3.0% and 2.2%, respectively. The 30-day permanent pacemaker implantation rate was 30.0% in all patients, and 34.6% in pacemaker-naïve patients. Echocardiographic data at baseline and pre-discharge were assessed by an independent core laboratory. Mean aortic valve gradient declined from 37.7 ± 15.2 mmHg at baseline to 10.8 ± 4.6 mmHg at hospital discharge (P < 0.001). Aortic valve area increased from 0.7 ± 0.2 cm2 at baseline to 1.8 ± 0.4 cm2 at discharge (P < 0.001). At hospital discharge, paravalvular leak (PVL) was absent or trace in 92% of patients; no patients had severe PVL, 0.3% of patients exhibited moderate PVL, and 7.7% of patients had mild PVL. Clinical follow-up in RESPOND will extend to 5 years.

Conclusion: The results of RESPOND confirm the safety and efficacy of TAVI with the Lotus Valve in routine clinical practice.

Trial registration: ClinicalTrials.gov #NCT 02031302.

Trial registration: ClinicalTrials.gov NCT02031302.

Keywords: Aortic regurgitation; Aortic valve stenosis; Transcatheter aortic valve replacement; Transfemoral.

Publication types

  • Evaluation Study
  • Multicenter Study

MeSH terms

  • Aged, 80 and over
  • Aortic Valve Insufficiency / mortality
  • Aortic Valve Insufficiency / physiopathology
  • Aortic Valve Insufficiency / surgery*
  • Aortic Valve Stenosis / mortality
  • Aortic Valve Stenosis / physiopathology
  • Aortic Valve Stenosis / surgery*
  • Aortic Valve*
  • Female
  • Heart Valve Prosthesis*
  • Hemodynamics / physiology
  • Humans
  • Male
  • Patient Reported Outcome Measures
  • Patient Safety
  • Postoperative Complications / etiology
  • Prospective Studies
  • Prosthesis Design
  • Quality of Life
  • Registries
  • Reoperation / statistics & numerical data
  • Transcatheter Aortic Valve Replacement / methods*
  • Transcatheter Aortic Valve Replacement / mortality
  • Treatment Outcome

Associated data

  • ClinicalTrials.gov/NCT02031302