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
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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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