CLINICAL RESEARCH: VALVULAR HEART DISEASE
Is It Reasonable to Treat All Calcified Stenotic Aortic Valves With a Valved Stent?Results From a Human Anatomic Study in Adults
Rachid Zegdi, MD, PhD*, , ,1,*,
Vlad Ciobotaru, MD*,,
Miléna Noghin, MD,
Ghassan Sleilaty, MD,
Antoine Lafont, MD, PhD, ,
Christian Latrémouille, MD, PhD*,,
Alain Deloche, MD*, and
Jean-Noël Fabiani, MD*,,
* Université René Descartes, Paris, France
AP-HP, Assistance Publique-hôpitaux de Paris, Service de Chirurgie Cardio-Vasculaire, Hôpital Européen Georges Pompidou, Paris, France
Inserm U849, Faculté de Necker, Paris, France
AP-HP, Assistance Publique-hôpitaux de Paris, Service de Cardiologie, Hôpital Européen Georges Pompidou, Paris, France.
Manuscript received June 21, 2007;
revised manuscript received September 18, 2007,
accepted October 8, 2007.
* Reprint requests and correspondence: Dr. Rachid Zegdi, Hôpital Européen Georges Pompidou, Service de Chirurgie Cardiovasculaire, 20 rue Leblanc, 75908 Paris, France. (Email: rzegdi{at}hotmail.com).
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.
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Abbreviations and Acronyms
| | AS = aortic stenosis | | AVI = aortic valve implantation | | AVR = aortic valve replacement | | VS = valved stent |
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