Good outcome and valve function despite Medtronic-corevalve underexpansion

Area of Science:

• Cardiology
• Interventional Cardiology
• Cardiac Surgery

Background:

• Severe calcific aortic stenosis and bicuspid aortic valve disease pose significant challenges, particularly in elderly patients with comorbidities.
• Conventional surgical valve replacement is often contraindicated in frail patients with poor left ventricular function and high surgical risk scores.
• Transcatheter aortic valve implantation (TAVI) offers a less invasive alternative for managing severe aortic stenosis in high-risk populations.

Observation:

• An 80-year-old female patient with severe calcific aortic stenosis and a bicuspid aortic valve was evaluated for TAVI due to ineligibility for conventional surgery.
• A 29-mm Medtronic-Corevalve bioprosthesis was successfully implanted via a transfemoral approach.
• Despite significant underexpansion of the stent frame's inflow portion, hemodynamic parameters were satisfactory, with an adequate aortic valve area and acceptable gradients.

Findings:

• The patient experienced early and sustained improvement in New York Heart Association (NYHA) functional class post-TAVI.
• Valvular function remained stable at the 2-year follow-up, indicating durable bioprosthetic performance.
• Hemodynamic assessment revealed a satisfactory aortic valve area (1.3 cm²/m²) and acceptable gradients (peak 23 mmHg, mean 16 mmHg).

Implications:

• Gross underexpansion of the Medtronic-Corevalve stent frame does not necessarily compromise bioprosthetic function or clinical outcomes.
• TAVI can achieve excellent symptomatic recovery and durable results even in complex cases with challenging valve anatomy and device deployment.
• This case underscores the importance of functional assessment and hemodynamic parameters in evaluating TAVI success, even in the presence of deployment variations.