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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

Carl J. Schultz, MD, PhD^_*, Annick Weustink, MD, Nicolo Piazza, MD^_*, Amber Otten, MSc^_*, Nico Mollet, MD, PhD, Gabriel Krestin, MD, PhD, Robert J. van Geuns, MD, PhD^_*, Pim de Feyter, MD, PhD^_*,, Patrick W.J. Serruys, MD, PhD^_* and Peter de Jaegere, MD, PhD^_*,_*

^_* Department of Cardiology, Erasmus Medical Center, Rotterdam, the Netherlands
Department of Radiology, Erasmus Medical Center, Rotterdam, the Netherlands

Manuscript received February 26, 2009; revised manuscript received April 20, 2009, accepted April 26, 2009.

^_* Reprint requests and correspondence: Dr. Peter de Jaegere, Department of Cardiology, Erasmus Medical Center, PB 412, 3000 CA Rotterdam, the Netherlands (Email: p.dejaegere{at}erasmusmc.nl).

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

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J. Am. Coll. Cardiol. 2009 54: A29. [Full Text] [PDF]