Document Detail

Is it reasonable to treat all calcified stenotic aortic valves with a valved stent? Results from a human anatomic study in adults.
MedLine Citation:
PMID:  18237689     Owner:  NLM     Status:  MEDLINE    
OBJECTIVES: This study was designed to study the behavior of a stent deployed inside human stenotic aortic valves. BACKGROUND: Endovascular valved stent (VS) implantation is a promising new therapy for patients with severe calcific aortic stenosis (AS). The precise characteristics of stent deployment in humans have been poorly studied so far. METHODS: Thirty-five patients with severe AS were included in the study. Sixteen patients (46%) had bicuspid aortic valves. A self-expandable stent specifically designed for VS implantation was deployed intraoperatively inside the aortic valve before surgical aortic valve replacement. RESULTS: In tricuspid aortic valves, the shape of stent deployment was circular, triangular, or elliptic in 68%, 21%, or 11%, respectively. Noncircular stent deployment was frequent in bicuspid aortic valves (the elliptic deployment being the rule [79%]), and stent underdeployment was constant. The incidence of gaps between the stent external surface and the aortic valve did not differ between tricuspid and bicuspid valves (58% vs. 43%; p = 0.49). Sharp calcific excrescences protruding inside the stent lumen were present in 3 cases (9%). Ex vivo study of a homemade VS confirmed that the regularity of the coaptation line of the leaflets was critically dependent on the presence or the absence of stent misdeployment. CONCLUSIONS: Stent misdeployment was constant in bicuspid valves and occurred in one-third of cases of tricuspid valves. Premature failure of implanted VS (secondary to valve distortion or traumatic injury to the leaflets by calcific excrescences) might be an important concern in the future.
Rachid Zegdi; Vlad Ciobotaru; Miléna Noghin; Ghassan Sleilaty; Antoine Lafont; Christian Latrémouille; Alain Deloche; Jean-Noël Fabiani
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Publication Detail:
Type:  Evaluation Studies; Journal Article    
Journal Detail:
Title:  Journal of the American College of Cardiology     Volume:  51     ISSN:  1558-3597     ISO Abbreviation:  J. Am. Coll. Cardiol.     Publication Date:  2008 Feb 
Date Detail:
Created Date:  2008-02-01     Completed Date:  2008-02-07     Revised Date:  2009-02-02    
Medline Journal Info:
Nlm Unique ID:  8301365     Medline TA:  J Am Coll Cardiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  579-84     Citation Subset:  AIM; IM    
Université René Descartes, Paris, France.
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MeSH Terms
Aged, 80 and over
Aortic Valve / anatomy & histology*,  surgery
Aortic Valve Stenosis / pathology,  physiopathology,  surgery*
Calcinosis / surgery*
Heart Valve Prosthesis Implantation*
Intraoperative Period
Middle Aged
Prosthesis Design
Stroke Volume
Comment In:
J Am Coll Cardiol. 2009 Jan 13;53(2):219; author reply 219-20   [PMID:  19130993 ]

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