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BACKGROUND The repositionable and fully retrievable LotusTM Valve (Boston Scientific, Marlborough, MA, USA) was designed to provide precise positioning and minimize paravalvular leak (PVL) in patients with severe aortic stenosis. This analysis will present the first report of 3-year outcomes from the REPRISE II CE-Mark study. METHODS The REPRISE II study is a prospective, single-arm trial that enrolled patients with symptomatic severe calcific aortic stenosis who are at high or extreme surgical risk (based on STS Score or Heart Team assessment) at 14 centers in Europe and Australia. Follow-up is continuing through 5 years. RESULTS Among 120 enrolled patients, the mean age was 84.4+/-5.3 years, 57% (68/120) were female, and mean STS Score was 7.1+/-4.6. All patients were successfully implanted with a Lotus Valve. The primary performance endpoint of 30-day mean aortic valve pressure gradient was 11.5+/-5.2mmHg, and was significantly less than the performance goal of 18mmHg (P<0.001). The primary safety endpoint of 30-day allcause mortality was 4.2%. Two-year clinical follow-up data or death was available for all patients. At 2 years, the Kaplan-Meier rate of allcause mortality was 16.9% (n=20) and disabling stroke was 3.5% (n=4). There were no repeat procedures for valve-related dysfunction, valve migration, embolization, or TAV-in-TAV. Two additional patients received a new permanent pacemaker (PPM) between 1 and 2 years (complete heart block on day 432 and symptomatic bradycardia on day 673) for a total 2-year PPM rate of 34.2% (n=40). By independent core lab adjudication, the 2-year mean aortic valve gradient was 12.3+/-6.2mmHg and mean aortic valve area was 1.7+/-0.5cm2. A total of 90.5% patients had no or trivial PVL at 2 years and 9.5% had mild paravalvular regurgitation; no patient had moderate or severe PVL. CONCLUSION The Lotus Valve has demonstrated negligible PVL, good sustained hemodynamics, and low rates of death and stroke at 2 years. The 3-year results

Aim: To define the role of imaging in the detection of complications in patients who have undergone endoluminal repair of aortic aneurysm disease. Method(s): A review of the literature and to present the experience of a busy tertiary vascular centre with particular emphasis on the following 1. The detection of endoleak 2. The classification of endoleaks 3. Mechanical failure of endografts 4. The mycotic endograft 5. Rupture of aneurysms after endografting Conclusion(s): The Radiologist has an important role in detecting adverse features after endoluminal aortic repair, these features are myriad and often subtle but with a systematic approach are able to be detected on routine CT imaging.

Aims: Early transcatheter aortic valve implantation (TAVI) devices have established the feasibility of TAVI in patients who are unsuitable for surgical valve replacement, but these devices may face challenges with precise valve positioning, paravalvular leakage, and undesirable rates of stroke, bleeding, or vascular complications. The repositionable and fully retrievable LotusTM Valve was designed to facilitate accurate positioning and minimise paravalvular leakage in patients with severe aortic stenosis who are at high or extreme risk for surgery. The device demonstrated favourable efficacy and safety primary outcomes at 30 days in the REPRISE II CE-Mark trial. This analysis will present the first report of 6-month outcomes in the full cohort of patients in REPRISE II. Methods and Results: The prospective, single-arm, multicentre REPRISE II study was designed to assess the safety and performance of the Lotus Valve System in symptomatic patients aged >=70 years with severe calcific aortic stenosis who are at high or extreme surgical risk. The primary device performance endpoint was the mean aortic valve pressure gradient at 30 days post-procedure, as assessed by an independent core laboratory. The primary safety endpoint was 30-day all-cause mortality. Among 120 enrolled patients, the mean age of 84.4+/-5.3 years, 57% (68/120) were female, mean STS Score was 7.1+/-4.6, mean euroSCORE II was 6.9+/-5.8, and 26% had medically treated diabetes. The mean baseline aortic valve area was 0.7+/-0.2 cm, and the mean aortic valve pressure gradient was 46.4+/-15.0 mmHg. All patients (100%) were successfully implanted with a Lotus valve. A total of 28.6% (34/119) patients had a permanent pacemaker implanted within 30 days post-procedure. The primary device performance endpoint of 30-day mean aortic valve pressure gradient was 11.5+/-5.2 mmHg, which was significantly less than the performance goal of 18 mmHg (P<0.001). All-cause mortality at 30 days was 4.2% and disabling stroke

Alagille syndrome (AS) is a dominantly inherited, multisystem disorder involving the liver, heart, eyes, face, and skeleton. From October 1997 through July 2004, 260 pediatric orthotopic liver transplantations (OLTx) were performed in 231 patients. This report describes 21 patients of median age 1.95 years (range, 0.7-16.7) who had alagille syndrome. We present the technical features of the OLTx, incidence and type of complications, medical conditions related to the syndrome, need for retransplantation, as well as patient and graft survival rates. A split liver technique was used in 16 patients (76%) who received a left lateral segment (LLS) graft whereas 7 patients (33%) received a whole liver. Only cadaveric donors were used. The major surgical complications requiring reintervention in 11 patients (52%) included biliary problems (19%) and vascular complications (17%). One case of hepatic artery thrombosis required retransplantation. Three recipients (14%) died. All other patients are alive with an actuarial survival rate of 90% at 1 year and 80% at 5 years. The actuarial graft survival rate is 85% at 1 year and 75% at 5 years. Patients with AS, despite the associated cardiovascular anomalies, can be treated successfully by a combined approach between cardiologist, radiologist, cardiothoracic, and liver transplant surgeons. With careful planning and operative management, the results are comparable with those obtained with other more common cholestatic diseases.