CORRESPONDENCE: LETTER TO THE EDITOR
Reply
Rachid Zegdi, MD, PhD*,
Ghassan Sleilaty, MD,
Antoine Lafont, MD, PhD and
Jean-Noël Fabiani, MD
* Hôpital Européen Georges Pompidou, Service de Chirurgie Cardiovasculaire, 20 Rue Leblanc, 75908 Paris, France (Email: rzegdi{at}hotmail.com).
We thank Dr. Napodano and colleagues for their valuable comments and their efforts to make our study more comprehensible (1). One should remark that the title of their letter implicitly suggests that adequate stent expansion is an important goal to be achieved during percutaneous valve implantation.
A major finding from our study was that stent expansion was inappropriate in all bicuspid aortic valves. From a purely geometric point of view, getting a full stent expansion in this type of anatomy is elusive because the length of the leaflet's margins is always lower than the circumference of the aortic orifice (in tricuspid aortic valves, these 2 lengths are close). The usual elliptical aspect of the stent in this clinical setting is attributable to the high leaflet rigidity in this disease, a fact well-known by surgeons (and typically depicted in Fig. 1 of our article [1]).
We completely agree with Napodano and colleagues on the fact that stent deployment in an arrested heart during 2 min (as in our study) may not reflect stent deployment in a beating heart in the long run. Perivalvular leak may regress, but this needs better characterization. If one assumes that stent expansion is a continuous process after valved stent deployment, then the prosthetic valve orifice is expected to increase with time (irrespective of the presence or absence of perivalvular leaks). In a recent study with detailed measurements of aortic valve function, the post-procedural aortic valve area remained stable during the first post-operative month, except in 1 case (with a poor initial result) (2).
To improve patients' management, further clinical investigations on the true incidence of stent misdeployment and its clinical impact on valve function and durability are required.
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1. Zegdi R, Ciobotaru V, Noghin M, et al. Is it reasonable to treat all calcified stenotic aortic valves with a valved stent?. Results from a human anatomic study in adults. J Am Coll Cardiol 2008;51:579-584.[Abstract/Free Full Text]2. Marcheix B, Lamarche Y, Berry C, et al. Surgical aspects of endovascular retrograde implantation of the aortic CoreValve bioprosthesis in high-risk older patients with severe symptomatic aortic stenosis J Thorac Cardiovasc Surg 2007;134:1150-1156.[Abstract/Free Full Text]
Related Article
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Is it Reasonable to Treat All Calcified Stenotic Valves With a Valve Stent?: Probably Yes If We Get a Full Stent Expansion
- Massimo Napodano, Giuseppe Tarantini, and Angelo Ramondo
J. Am. Coll. Cardiol. 2009 53: 219.
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