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

https://doi.org/10.1016/j.jacc.2009.04.075Get rights and content
Under an Elsevier user license
open archive

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.

Key Words

cardiac computed tomography
percutaneous valve replacement
aortic valve

Abbreviations and Acronyms

CRS
CoreValve ReValving System
CSA
cross-sectional surface area
D1
smallest diameter
D2
largest diameter
IQR
interquartile range
LVOT
left ventricular outflow tract
MSCT
multislice computed tomography
PAVR
percutaneous aortic valve replacement
TTE
transthoracic echocardiography

Cited by (0)