Data from the REPRISE I feasibility trial, presented on 15 May at EuroPCR , showed successful deployment of the Lotus Aortic Valve System (Boston Scientific) in all patients (11) with virtually no paravalvular regurgitation after valve placement or at discharge.
The REPRISE I trial evaluated the acute safety of the Lotus Aortic Valve System in patients with severe aortic valve disease. The Lotus Aortic Valve System is the first transcatheter aortic valve implantation (TAVI) device of its kind that is designed to minimise aortic regurgitation and is both fully repositionable and retrievable prior to release.
“Perhaps the most impressive feature of the Lotus Valve System in this study was the ability to precisely position the valve on the first attempt, eliminating the need for repositioning, although this capability was available if needed,” said Ian Meredith, professor and director of MonashHeart, at Monash Medical Centre in Melbourne, Australia, and principal investigator of the trial. “Another striking feature was that the valve operated early in the deployment process, providing us some comfort and time to consider the valve position, as well as the immediate and almost complete obliteration of aortic regurgitation even in patients who had moderately severe aortic regurgitation after balloon valvuloplasty. In this regard, I think the Lotus valve technology is somewhat unique.”
REPRISE I is a prospective, single-arm feasibility study that enrolled 11 patients at three sites in Australia. The primary endpoint is defined as successful device implantation without in-hospital major adverse cardiovascular or cerebrovascular events (MACCE) through discharge or seven days post-procedure (whichever comes first). In-hospital MACCE includes death, heart attack, major stroke, and conversion to surgery or repeat procedure due to valve-related dysfunction. All patients had severe symptomatic aortic stenosis and were considered at high risk for surgical valve replacement. No in-hospital MACCE were reported in 91% (10 of the 11) of patients. One stroke and no deaths were observed. No moderate or severe paravalvular regurgitation was present after valve placement or at discharge.
“The REPRISE I results underscore the unique technology behind the Lotus Aortic Valve System, which offers interventional cardiologists greater precision and control in deployment while at the same time minimising the occurrence of aortic regurgitation. These features help to simplify the implantation procedure, and will potentially lead to improved clinical outcomes,” said Keith D Dawkins, global chief medical officer, Boston Scientific. “We look forward to advancing the Lotus Aortic Valve System clinical programme by initiating patient enrolment in the REPRISE II study later this year.”
The REPRISE II trial is designed to evaluate the safety and performance of the Lotus Aortic Valve System in 120 patients at up to 15 sites in Australia and Europe. Data from the trial are expected to be used to support CE mark and other international regulatory approvals. Enrolment is expected to be completed in the first half of 2013.
About the Lotus Aortic Valve System
The Lotus Aortic Valve System is a differentiated second-generation TAVI technology, which consists of a pre-loaded, stent-mounted tissue valve prosthesis and catheter delivery system for guidance and percutaneous placement of the valve. The low-profile delivery system and introducer sheath are designed to enable predictable and precise placement, as well as bi-directional atraumatic repositioning and retrieval at any time prior to release of the aortic valve implant. The device also employs a unique Adaptive Seal feature designed to minimise the incidence of paravalvular regurgitation, which has proven to be a predictor of mortality.
The Lotus Aortic Valve System is an investigational device, limited by applicable law to investigational use and not available for sale. The device was developed by Sadra Medical, which Boston Scientific acquired in 2011.