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

Marguerite E. Faure*, Dominika Suchá, Fides R. Schwartz, Ad J.J.C. Bogers, Petr Symersky, Jeffrey G. Gaca, Lynne M. Koweek, Linda M. de Heer, Ricardo P.J. Budde

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review


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.

Original languageEnglish
Pages (from-to)2651-2657
Number of pages7
JournalEuropean Radiology
Issue number5
Early online date1 Jan 2020
Publication statusPublished - 1 May 2020

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