title: Is it reasonable to treat all calcified stenotic aortic valves with a valved stent? Results from a human anatomic study in adults.
abstract: OBJECTIVE
  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.
authors.affiliation: Université René Descartes, Paris, France. rzegdi@hotmail.com
authors.forename: Rachid
authors.initials: R
authors.lastname: Zegdi
authors.forename: Vlad
authors.initials: V
authors.lastname: Ciobotaru
authors.forename: Miléna
authors.initials: M
authors.lastname: Noghin
authors.forename: Ghassan
authors.initials: G
authors.lastname: Sleilaty
authors.forename: Antoine
authors.initials: A
authors.lastname: Lafont
authors.forename: Christian
authors.initials: C
authors.lastname: Latrémouille
authors.forename: Alain
authors.initials: A
authors.lastname: Deloche
authors.forename: Jean-Noël
authors.initials: JN
authors.lastname: Fabiani
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000033:anatomy & histology* / Q000601:surgery; D001024:Aortic Valve Stenosis / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D002114:Calcinosis / Q000601:surgery*; D005260:Female; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D007432:Intraoperative Period; D008297:Male; D008875:Middle Aged; D011474:Prosthesis Design; D015607:Stents; D013318:Stroke Volume