Document Detail

Geometry and degree of apposition of the CoreValve ReValving system with multislice computed tomography after implantation in patients with aortic stenosis.
MedLine Citation:
PMID:  19712801     Owner:  NLM     Status:  MEDLINE    
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 cm(2) (IQR 0.9 to 2.6 cm(2)) and 0.5 cm(2) (IQR 0.2 to 0.7 cm(2)) 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.
Carl J Schultz; Annick Weustink; Nicolo Piazza; Amber Otten; Nico Mollet; Gabriel Krestin; Robert J van Geuns; Pim de Feyter; Patrick W J Serruys; Peter de Jaegere
Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Journal of the American College of Cardiology     Volume:  54     ISSN:  1558-3597     ISO Abbreviation:  J. Am. Coll. Cardiol.     Publication Date:  2009 Sep 
Date Detail:
Created Date:  2009-08-28     Completed Date:  2009-09-23     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8301365     Medline TA:  J Am Coll Cardiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  911-8     Citation Subset:  AIM; IM    
Department of Cardiology, Erasmus Medical Center, Rotterdam, the Netherlands.
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MeSH Terms
Aged, 80 and over
Aortic Valve / radiography*,  surgery
Aortic Valve Stenosis / physiopathology,  radiography,  surgery*
Blood Flow Velocity
Heart Catheterization
Heart Valve Prosthesis*
Heart Valve Prosthesis Implantation*
Prosthesis Design
Tomography, X-Ray Computed*

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