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Surgically implanted aortic valve bioprostheses deform after implantation: insights from computed tomography

  • Cardiac
  • Published:
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Abstract

Objective

Little is known about the prevalence and degree of deformation of surgically implanted aortic biological valve prostheses (bio-sAVRs). We assessed bio-sAVR deformation using multidetector-row computed tomography (MDCT).

Methods

Three imaging databases were searched for patients with MDCT performed after bio-sAVR implantation. Minimal and maximal valve ring diameters were obtained in systole and/or diastole, depending on the acquired cardiac phase(s). The eccentricity index (EI) was calculated as a measure of deformation as (1 − (minimal diameter/maximal diameter)) × 100%. EI of < 5% was considered none or trivial deformation, 5–10% mild deformation, and > 10% non-circular. Indications for MDCT and implanted valve type were retrieved.

Results

One hundred fifty-two scans of bio-sAVRs were included. One hundred seventeen measurements were performed in systole and 35 in diastole. None or trivial deformation (EI < 5%) was seen in 67/152 (44%) of patients. Mild deformation (EI 5–10%) was seen in 59/152 (39%) and non-circularity was found in 26/152 (17%) of cases. Overall, median EI was 5.5% (IQR 3.4–7.8). In 77 patients, both systolic and diastolic measurements were performed from the same scan. For these scans, the median EI was 6.5% (IQR 3.4–10.2) in systole and 5.1% (IQR3.1–7.6) in diastole, with a significant difference between both groups (p = 0.006).

Conclusions

Surgically implanted aortic biological valve prostheses show mild deformation in 39% of cases and were considered non-circular in 17% of studied valves.

Key Points

• Deformation of surgically implanted aortic valve bioprostheses (bio-sAVRs) can be adequately assessed using MDCT.

• Bio-sAVRs show at least mild deformation (eccentricity index > 5%) in 56% of studied cases and were considered non-circular (eccentricity index > 10%) in 17% of studied valves.

• The higher deformity rate found in bio-sAVRs with (suspected) valve pathology could suggest that geometric deformity may play a role in leaflet malformation and thrombus formation similar to that of transcatheter heart valves.

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Abbreviations

AVR:

Aortic valve replacement

Bio-sAVR:

Biological surgical aortic valve replacement

EI:

Eccentricity index

IQR:

Interquartile range

MDCT:

Multidetector-row computed tomography

sAVR:

Surgical aortic valve replacement

SVD:

Structural valve deterioration

TAVI:

Transcatheter aortic valve implantation

THV:

Transcatheter heart valve

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Funding

The authors state that this work has not received any funding.

Author information

Authors and Affiliations

  1. Department of Radiology and Nuclear Medicine, Erasmus Medical Center, Po Box 2040, 3000, CA, Rotterdam, The Netherlands

    Marguerite E. Faure & Ricardo P. J. Budde

  2. Department of Radiology, AZ Monica, Antwerp, Belgium

    Marguerite E. Faure

  3. Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands

    Dominika Suchá

  4. Department of Radiology, Duke University Medical Center, Durham, USA

    Fides R. Schwartz & Lynne M. Koweek

  5. Department of Cardiothoracic Surgery, VU Medical Center, Amsterdam, The Netherlands

    Petr Symersky

  6. Department of Cardiothoracic Surgery, Erasmus Medical Center, Rotterdam, The Netherlands

    Ad J. J. C. Bogers

  7. Department of Cardiothoracic Surgery, Duke University Medical Center, Durham, USA

    Jeffrey G. Gaca

  8. Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, The Netherlands

    Linda M. de Heer

  9. Department of Cardiothoracic Surgery, University Medical Center Utrecht, Utrecht, The Netherlands

    Linda M. de Heer

Authors
  1. Marguerite E. Faure
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  2. Dominika Suchá
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Corresponding author

Correspondence to Marguerite E. Faure.

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Guarantor

The scientific guarantor of this publication is Ricardo Budde, Erasmus MC, Rotterdam.

Conflict of interest

The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

Statistics and biometry

No complex statistical methods were necessary for this paper.

Ethical approval

Institutional Review Board approval was not required because the acquisition was a part of the routine clinical workup, and data were gathered retrospectively. No additional acquisitions were made specifically for this study. Patient data were retrieved from the electronic patient file.

Methodology

• retrospective

• observational

• performed at three institutions

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Publisher’s note

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Marguerite E. Faure and Dominika Suchá contributed equally to this work.

Electronic supplementary material

Video 1

Manually deforming the stent frame of a bio-sAVR: The video demonstrates how most bio-sAVR stent frames can easily be deformed by external forces. (MP4 1636 kb)

Video 2

In retrospectively scanned patients, a video of the bio-sAVR shows the movement of the valve during all cardiac phases. (MP4 2506 kb)

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Faure, M.E., Suchá, D., Schwartz, F.R. et al. Surgically implanted aortic valve bioprostheses deform after implantation: insights from computed tomography. Eur Radiol 30, 2651–2657 (2020). https://doi.org/10.1007/s00330-019-06634-6

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  • DOI: https://doi.org/10.1007/s00330-019-06634-6

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