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• W2000738920 abstract "Endovascular aortic valve implantation has recently been proved to be feasible in aortic stenosis using either self-expandable or balloon-expandable valved stents. Future studies will try to define which patients suffering from severe aortic valve stenosis may truly benefit from endovascular valve implantation. Our first intuition as surgeons is that bicuspidy may not be a good anatomic form for endovascular valve implantation. Valvular calcification is usually exuberant and the valvular’s opening shape tends to be elliptical rather than circular. Elliptical deployment of valved stents will inevitably create valve distortion that may impede their long-term durability. We report two cases of intraoperative aortic valve stenting with a nitinol, self-expandable stent performed just before conventional aortic valve replacement. Both patients gave their informed consent before surgery. In the first case, the stenotic native aortic valve is tricuspid (Fig 1, left). After stenting, the stent was fully deployed within the aortic valve. It conserved its circular cross-sectional shape (Fig 1, right), and its anchorage to the surrounding tissue was judged as strong. There was no evidence of any gap between the outer surface of the stent and the inner surface of the aortic leaflets. As shown in Figure 2, the native stenotic aortic valve is bicuspid (Fig 2, left). The full cylindrical deployment of the stent was prevented by an uncompressible heavily calcified anterior leaflet. The cross-section of the stent was elliptic (Fig 2, right) and a gap was present at one commissure (arrow). The two reported cases here are part of an ongoing anatomic study (approved by our Institutional Review Board), which was designed for a better understanding of the behavior of a stent within a calcified aortic valve. Suboptimal results from previously reported studies of endovascular valve implantation may be explained in large part by misdeployment of the valved stents, being itself related to the pathology of the stenotic aortic valve. Our two cases were found particularly demonstrative in that sense, showing that bicuspidy may have a potentially negative impact on the deployment of valved stents. Future clinical studies should clarify this important issue owing to the high incidence of bicuspidy (50% in the surgical series) in severe aortic stenosis." @default.
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• W2000738920 date "2008-01-01" @default.
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• W2000738920 title "Calcific Bicuspid Aortic Stenosis: A Questionable Indication for Endovascular Valve Implantation?" @default.
• W2000738920 doi "https://doi.org/10.1016/j.athoracsur.2007.02.064" @default.
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