TY - JOUR
T1 - Subclinical leaflet thickening and stent frame geometry in self-expanding transcatheter heart valves
AU - Fuchs, Andreas
AU - De Backer, Ole
AU - Brooks, Matthew
AU - De Knegt, Martina C.
AU - Bieliauskas, Gintautas
AU - Yamamoto, Masanori
AU - Yanagisawa, Ryo
AU - Hayashida, Kentaro
AU - Søndergaard, Lars
AU - Kofoed, Klaus F.
N1 - Funding Information:
O. De Backer and G. Bieliauskas have been consultants for St. Jude Medical. L. Søndergaard has been a consultant and has received research grants from St. Jude Medical and Medtronic. The other authors have no conflicts of interest to declare.
Publisher Copyright:
© Europa Digital & Publishing 2017. All rights reserved.
PY - 2017/10
Y1 - 2017/10
N2 - Aims: This study aimed to assess the potential relationship between subclinical leaflet thickening and stent frame geometry in patients who underwent aortic valve replacement with a self-expanding transcatheter heart valve (THV). Methods and results: Seventy-five patients with a self-expanding THV were studied with 4D-computed tomography and analysed for leaflet thickening. There was no difference in THV size, overall THV expansion, eccentricity or implantation depth between patients with and those without leaflet thickening. Moderate-to-severe regional THV underexpansion (≤90°) more frequently occurred at the non-coronary and right coronary cusps with a significantly higher incidence of leaflet thickening than in cases of full regional THV expansion (24% vs. 3%, p<0.01). Regional THV underexpansion at the inflow level more often translated into the same issue at the valvular level in THV with intra-annular as compared to supra-annular valve position (54% vs. 17%; p=0.04). In case of post-dilatation, regional THV underexpansion occurred less frequently as compared to THV that were not post-dilated (18% vs. 43%, p=0.028). A similar but nonsignificant trend was found for leaflet thickening. Conclusions: Regional THV stent frame underexpansion is associated with an increased risk of leaflet thickening. Post-dilatation of self-expanding THV as well as a supra-annular valve position seem to reduce the occurrence of this phenomenon.
AB - Aims: This study aimed to assess the potential relationship between subclinical leaflet thickening and stent frame geometry in patients who underwent aortic valve replacement with a self-expanding transcatheter heart valve (THV). Methods and results: Seventy-five patients with a self-expanding THV were studied with 4D-computed tomography and analysed for leaflet thickening. There was no difference in THV size, overall THV expansion, eccentricity or implantation depth between patients with and those without leaflet thickening. Moderate-to-severe regional THV underexpansion (≤90°) more frequently occurred at the non-coronary and right coronary cusps with a significantly higher incidence of leaflet thickening than in cases of full regional THV expansion (24% vs. 3%, p<0.01). Regional THV underexpansion at the inflow level more often translated into the same issue at the valvular level in THV with intra-annular as compared to supra-annular valve position (54% vs. 17%; p=0.04). In case of post-dilatation, regional THV underexpansion occurred less frequently as compared to THV that were not post-dilated (18% vs. 43%, p=0.028). A similar but nonsignificant trend was found for leaflet thickening. Conclusions: Regional THV stent frame underexpansion is associated with an increased risk of leaflet thickening. Post-dilatation of self-expanding THV as well as a supra-annular valve position seem to reduce the occurrence of this phenomenon.
KW - Computed tomography (CT)
KW - Leaflet thickening
KW - Stent frame geometry
KW - Transcatheter aortic valve replacement (TAVR)
KW - Transcatheter heart valve (THV)
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U2 - 10.4244/EIJ-D-17-00373
DO - 10.4244/EIJ-D-17-00373
M3 - Article
C2 - 28741579
AN - SCOPUS:85032452860
VL - 13
SP - e1067-e1075
JO - EuroIntervention
JF - EuroIntervention
SN - 1774-024X
IS - 9
ER -