Evaluation of biological aortic valve prostheses by dual source computer tomography and anatomic measurements for potential transapical valve-in-valve procedure

Transapical aortic valve replacement has been introduced into clinical practice from which also patients with failing biological valves might profit: valve-in-valve procedure. The aim of the study was to determine the fate of biological valves in long-term follow-up (FU) and to evaluate topography and dimensions for transapical access via dual-source CT scan (DSCT). Fifty patients (mean age 76+/-13 years, range 38-87 years) underwent DSCT whereas the patients were followed for up to 13 years after porcine aortic valve replacement. Measurements of valve prosthesis and illustration of chest topography were done. Out of 46 evaluable patients, 34 showed no leaflet calcification and 12 minimally calcified. Seventeen valves (37%) showed no, 24 valves (52%) mild and 5 (11%) moderate-to-severe ring calcification. Three patients had moderate aortic stenosis, two patients showed mild insufficiency. The angle from the 4th ICS to apex to aortic valve annulus measured 80.3+/-11.1 degrees compared to the angle from the 5th ICS which measured 101.6+/-7.2 degrees (P<0.0001). Biological valves show good long-term results with minimal failure rate and limited calcification. Leaflet calcification might be problematic if unevenly distributed which can endanger the very close LCO. These measurements represent a prerequisite for preoperative planning and increase the awareness to detect potential procedural problems of the valve-in-valve concept.