HOME SUBSCRIPTIONS CURRENT ISSUE PAST ISSUES CARDIOSOURCE SEARCH HELP FEEDBACK		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Figures Only Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in ISI Web of Science Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Zegdi, R. Articles by Fabiani, J.-N. Search for Related Content PubMed Articles by Zegdi, R. Articles by Fabiani, J.-N. Related Collections Related Article

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.

Abbreviations and Acronyms   AS = aortic stenosis   AVI = aortic valve implantation   AVR = aortic valve replacement   VS = valved stent

Related Article

Inside This Issue of JACC
J. Am. Coll. Cardiol. 2008 51: A29-A30. [Full Text] [PDF]

This article has been cited by other articles:

				A. Vahanian, O. R. Alfieri, N. Al-Attar, M. J. Antunes, J. Bax, B. Cormier, A. Cribier, P. De Jaegere, G. Fournial, A. P. Kappetein, et al. Transcatheter valve implantation for patients with aortic stenosis: a position statement from the European Association of Cardio-Thoracic Surgery (EACTS) and the European Society of Cardiology (ESC), in collaboration with the European Association of Percutaneous Cardiovascular Interventions (EAPCI). Eur. J. Cardiothorac. Surg., July 1, 2008; 34(1): 1 - 8. [Abstract] [Full Text] [PDF]

				M. J. Antunes Percutaneous aortic valve implantation. The demise of classical aortic valve replacement? Eur. Heart J., June 1, 2008; 29(11): 1339 - 1341. [Full Text] [PDF]

				A. Vahanian, O. Alfieri, N. Al-Attar, M. Antunes, J. Bax, B. Cormier, A. Cribier, P. De Jaegere, G. Fournial, A. P. Kappetein, et al. Transcatheter valve implantation for patients with aortic stenosis: a position statement from the European Association of Cardio-Thoracic Surgery (EACTS) and the European Society of Cardiology (ESC), in collaboration with the European Association of Percutaneous Cardiovascular Interventions (EAPCI) Eur. Heart J., June 1, 2008; 29(11): 1463 - 1470. [Abstract] [Full Text] [PDF]