Toe guidance may not be required for tavrwith the repositionable lotus valve.

Objective: Determine the impact of transoesophageal echocardiography (TOE) guidance on outcomes in patients undergoing TAVR with the repositionable Lotus valve. Introduction: Early in the TAVR experience, the procedure was largely performed with TOE guidance. Given the repositionability of the Lotus valve, TOE guidance and therefore general anaesthesia may be avoided. Method(s): Consecutive patients undergoing TAVR (Lotus) were divided into 2 groups (TOE-guided and fluoroscopyguided procedure). Data was collected on baseline demographics, peri-procedural complications and 30-day followup. The association between the presence of aortic regurgitation (AR) at 1 month and fluoroscopy guidance was assessed with a logistic regression analysis. Associations with procedural mortality, rates of procedural stroke/myocardial infarction (MI), permanent pacemaker (PPM) requirement, acute kidney injury (AKI), length of stay and need for rehabilitation were also assessed. Result(s): There were no significant differences in baseline characteristics between TOE (n=75) and fluoroscopy-guided (n=28) procedures (mean age 83.3 vs 82.8y, p 0.7). Fluoroscopy guidance was not associated with AR at 1 month (OR 0.72, CI 0.3-1.9, p 0.5). There were no differences in procedural mortality (0 in both groups), stroke (0 in both groups), MI (0 in both groups), PPM requirement (25% in both groups) or AKI (21 vs 24%, 0.7). There was also no difference in length of stay (5 vs 6 days, p 0.7) or need for rehabilitation (28 vs 25%, p 0.7). Conclusion(s): In a cohort with a low volume of fluoroscopy guided Lotus TAVR procedures, there appears to be no difference in outcomes compared with TOE-guidance.