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Self-Expandable Prosthesis Valve Adaptation: Non-Uniform Expansion and Stent Frame Decoupling
Marco Moscarelli1, Giulia Sollami2, Emanuele Lentini1
1Departments of Cardiovascular Surgery, Maria Eleonora Hospital, GVM Care & Research, Palermo, Italy.
The American Journal of Cardiology
|September 21, 2023
Summary
Non-uniform expansion and stent-frame decoupling are common after self-expandable transcatheter heart valve (THV) replacement, impacting valve performance. Further research is needed to understand the clinical implications of these findings.
Area of Science:
- Cardiovascular Imaging
- Medical Device Engineering
- Interventional Cardiology
Background:
- Non-uniform expansion and stent-frame decoupling in self-expandable transcatheter heart valves (THVs) are not well-understood phenomena.
- Stent-frame decoupling involves the lower THV stent adapting to the left ventricle outflow tract's ellipticity while the upper part remains circular.
Purpose of the Study:
- To investigate the incidence and characteristics of non-uniform expansion and stent-frame decoupling in self-expandable THVs post-implantation.
- To assess the relationship between these phenomena and other implantation parameters.
Main Methods:
- Analysis of post-implant multi-detector computed tomography scans in 50 patients.
- Quantification of prosthesis eccentricity at six defined levels to assess non-uniform expansion.
- Comparison of eccentricity across levels to evaluate stent-frame decoupling.
- Calculation of implantation depth, leaflet expansion/alignment, and sinus area ratios.
Main Results:
- Non-uniform expansion was consistently detected across all valvular levels at 12 months.
- Highest eccentricity was observed at the native annulus (0.54 ± 0.12), lowest at the frame outflow (0.23 ± 0.11).
- A significant decrease in eccentricity from the annulus to the frame outflow was noted (p <0.001).
- Mild-to-severe subclinical leaflet thrombosis occurred in 16% of patients.
Conclusions:
- Prosthesis non-uniform expansion and stent-frame decoupling are frequent occurrences following self-expandable THV implantation.
- The clinical and hemodynamic significance of these findings requires further investigation.
