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J Thorac Cardiovasc Surg 2008;135:1407-1408
© 2008 The American Association for Thoracic Surgery

Letter to the Editor

Percutaneous aortic valve replacement with the CoreValve bioprosthesis

^a Assistance Publique-Hôpitaux de Paris AP-HP, Service de Chirurgie Cardiovasculaire, Hôpital Européen Georges Pompidou, Paris, France
^b Université René Descartes, Paris, France

To the Editor:

We read with interest the recent article by Marcheix and colleagues¹ in the Journal dealing with percutaneous aortic valve implantation. They reported their experience using the second generation (21F) of the CoreValve prosthesis (CoreValve, Inc, Paris, France) in 10 consecutive high-risk surgical patients (median logistic EuroSCORE of 32%). The prosthesis was successfully delivered in all cases, with a doubling of the aortic valve area (from 0.57 ± 0.19 to 1.2 ± 0.35 cm²) and a significant decrease in transvalvular gradient.

We would like to comment on these results and also ask for some clarifications regarding their data:

Prosthesis sizing is an important issue. On one hand, undersizing may be responsible for valve migration (owing to poor anchoring), perivalvular leak, or patient–prosthesis mismatch. On the other hand, oversizing may theoretically lead to coronary obstruction or favor atrioventricular block. There is actually only one available size of the CoreValve prosthesis, with a 21-mm bioprosthesis implanted within the stent frame. This valve is at the present time indicated when the aortic annulus diameter ranges from 20 to 27 mm.² Although the authors did not report the annulus size in their group of patients, we do not understand how proper sizing could be achieved with a single-sized bioprosthesis.

Aortic bicuspidy is observed in half of cases of severe aortic stenosis.³ In our experience, misdeployment of a valved stent is likely to occur within a bicuspid aortic valve,^4,5 which may alter its long-term durability. Did the authors face a case with a bicuspid aortic valve or have they systematically preoperatively screened the patients and excluded for the endovascular procedure those with a bicuspid aortic valve?

Although this study summarizes an initial experience, we thank the authors for sharing with us their results and for their contribution to this important new field of interventional therapy.

References

1. Marcheix B, Lamarche Y, Berry C, Asgar A, Laborde J-C, Basmadjian A, et al. Surgical aspects of endovascular retrograde implantation of the aortic CoreValve bioprosthesis in high-risk older patients with severe symptomatic aortic stenosis. J Thorac Cardiovasc Surg 2007;134:1150-1156.[Abstract/Free Full Text]
   
2. Grube E, Schuler G, Buellesfeld L, Gerckens U, Linke A, Wenaweser P, et al. Percutaneous aortic valve replacement for severe aortic stenosis in high-risk patients using the second- and current third-generation self-expanding CoreValve prosthesis. J Am Coll Cardiol 2007;50:69-76.[Abstract/Free Full Text]
   
3. Roberts WC, Ko JM. Frequency by decades of unicuspid, bicuspid, and tricuspid aortic valves in adults having isolated aortic valve replacement for aortic stenosis, with or without associated aortic regurgitation. Circulation 2005;111:920-925.[Abstract/Free Full Text]
   
4. Zegdi R, Khabbaz Z, Ciobotaru V, Noghin M, Deloche A, Fabiani JN. Calcific bicuspid aortic stenosis: a questionable indication for endovascular valve implantation? Ann Thorac Surg. In press.
   
5. Zegdi R, Ciobotaru V, Noghin M, Sleilaty G, Lafont A, Latrémouille C, et al. Is it reasonable to treat all calcific stenotic aortic valves with a valved stent? Results from a human anatomic study in adults. J Am Coll Cardiol. In press.
   

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Paul Achouh Jean-Noël Fabiani Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Zegdi, R. Articles by Fabiani, J.-N. Search for Related Content PubMed Articles by Zegdi, R. Articles by Fabiani, J.-N. Related Collections Cardiac - physiology Extracorporeal circulation Valve disease Related Articles