Geometry and Degree of Apposition of the CoreValve ReValving System With Multislice Computed Tomography After Implantation in Patients With Aortic Stenosis

• Published in: Journal of the American College of Cardiology Vol. 54; no. 10; pp. 911 - 918
• Main Authors: Schultz, Carl J., MD, PhD, Weustink, Annick, MD, Piazza, Nicolo, MD, Otten, Amber, MSc, Mollet, Nico, MD, PhD, Krestin, Gabriel, MD, PhD, van Geuns, Robert J., MD, PhD, de Feyter, Pim, MD, PhD, Serruys, Patrick W.J., MD, PhD, de Jaegere, Peter, MD, PhD
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01-09-2009; Elsevier; Elsevier Limited
• Subjects: Aged; Aged, 80 and over; aortic valve; Aortic Valve - diagnostic imaging; Aortic Valve - surgery; Aortic Valve Stenosis - diagnostic imaging; Aortic Valve Stenosis - physiopathology; Aortic Valve Stenosis - surgery; Biological and medical sciences; Blood Flow Velocity; Cardiac Catheterization; cardiac computed tomography; Cardiology; Cardiology. Vascular system; Cardiovascular; Echocardiography; Endocardial and cardiac valvular diseases; Female; Geometry; Heart; Heart Valve Prosthesis; Heart Valve Prosthesis Implantation; Humans; Internal Medicine; Male; Medical imaging; Medical sciences; Patients; percutaneous valve replacement; Prostheses; Prosthesis Design; Sinuses; Statistical methods; Tomography, X-Ray Computed; aortic valve; CoreValve ReValving System; TTE; CRS; cardiac computed tomography; smallest diameter; PAVR; left ventricular outflow tract; transthoracic echocardiography; IQR; interquartile range; LVOT; D1; D2; CSA; cross-sectional surface area; MSCT; largest diameter; multislice computed tomography; percutaneous valve replacement; percutaneous aortic valve replacement; Human; Aortic stenosis; Radiodiagnosis; Cardiovascular disease; Implantation; Patient; System; Geometry; Cardiac valvular disease; Medical imagery; Multislice; Computerized axial tomography; Circulatory system; Cardiology
• ISSN: 0735-1097; 1558-3597
• DOI: 10.1016/j.jacc.2009.04.075

Objectives Using multislice computed tomography (MSCT), we sought to evaluate the geometry and apposition of the CoreValve ReValving System (CRS, Medtronic, Luxembourgh, Luxembourgh) in patients with aortic stenosis. Background There are no data on the durability of percutaneous aortic valve replacement. Geometric factors may affect durability. Methods Thirty patients had MSCT at a median 1.5 months (interquartile range [IQR] 0 to 7 months) after percutaneous aortic valve replacement. Axial dimensions and apposition of the CRS were evaluated at 4 levels: 1) the ventricular end; 2) the nadir; 3) central coaptation of the CRS leaflets; and 4) commissures. Orthogonal smallest and largest diameters and cross-sectional surface area were measured at each level. Results The CRS (26-mm: n = 14, 29-mm: n = 16) was implanted at 8.5 mm (IQR 5.2 to 11.0 mm) below the noncoronary sinus. None of the CRS frames reached nominal dimensions. The difference between measured and nominal cross-sectional surface area at the ventricular end was 1.6 cm2 (IQR 0.9 to 2.6 cm2 ) and 0.5 cm2 (IQR 0.2 to 0.7 cm2 ) at central coaptation. At the level of central coaptation the CRS was undersized relative to the native annulus by 24% (IQR 15% to 29%). The difference between the orthogonal smallest and largest diameters (degree of deformation) at the ventricular end was 4.4 mm (IQR 3.3 to 6.4 mm) and it decreased progressively toward the outflow. Incomplete apposition of the CRS frame was present in 62% of patients at the ventricular end and was ubiquitous at the central coaptation and higher. Conclusions Dual-source MSCT demonstrated incomplete and nonuniform expansion of the CRS frame, but the functionally important mid-segment was well expanded and almost symmetrical. Undersizing and incomplete apposition were seen in the majority of patients.