title: Geometry and degree of apposition of the CoreValve ReValving system with multislice computed tomography after implantation in patients with aortic stenosis.
abstract: OBJECTIVE
  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 cm(2) (IQR 0.9 to 2.6 cm(2)) and 0.5 cm(2) (IQR 0.2 to 0.7 cm(2)) 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.
authors.affiliation: Department of Cardiology, Erasmus Medical Center, Rotterdam, the Netherlands.
authors.forename: Carl J
authors.initials: CJ
authors.lastname: Schultz
authors.forename: Annick
authors.initials: A
authors.lastname: Weustink
authors.forename: Nicolo
authors.initials: N
authors.lastname: Piazza
authors.forename: Amber
authors.initials: A
authors.lastname: Otten
authors.forename: Nico
authors.initials: N
authors.lastname: Mollet
authors.forename: Gabriel
authors.initials: G
authors.lastname: Krestin
authors.forename: Robert J
authors.initials: RJ
authors.lastname: van Geuns
authors.forename: Pim
authors.initials: P
authors.lastname: de Feyter
authors.forename: Patrick W J
authors.initials: PW
authors.lastname: Serruys
authors.forename: Peter
authors.initials: P
authors.lastname: de Jaegere
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000000981:diagnostic imaging* / Q000601:surgery; D001024:Aortic Valve Stenosis / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D001783:Blood Flow Velocity; D006328:Cardiac Catheterization; D004452:Echocardiography; D005260:Female; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D008297:Male; D011474:Prosthesis Design; D014057:Tomography, X-Ray Computed