Subclinical leaflet thickening and stent frame geometry in self-expanding transcatheter heart valves

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

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.

U2 - 10.4244/EIJ-D-17-00373

DO - 10.4244/EIJ-D-17-00373

M3 - Journal article

C2 - 28741579

SN - 1774-024X

VL - 13

SP - e1067-e1075

JO - EuroIntervention

JF - EuroIntervention

IS - 9

ER -