Very Early and Unusual Aortic Bioprosthetic Valve Deterioration 9 Months after Implantation

Abstract

Every component of valvular bioprostheses is prone to variable structural deterioration secondary to multifactorial etiopathogenesis. Calcific degeneration is the most common phenomenon. However, it is a slow process in the elderly and typically starts after several years of implantation. We herein report a very early bioprosthesis deterioration of unknown etiology due to inward bending of the stent posts (“stent creep”) causing severe aortic stenosis. Nine months after aortic valve replacement with a 21-mm Epic Supra bioprosthesis (St. Jude Medical, St. Paul, MN, USA) with concomitant coronary artery bypass grafting and carotid endarterectomy, valve orifice narrowing with leaflet restriction and markedly reduced geometric orifice of the outflow causing severe valvular stenosis was documented in a 72-year-old man. A possible reason for this extremely early deterioration was circumferential compression of the bioprosthesis stent causing inward bending of the stent posts. The patient refused redo surgery and continued to be symptomatic with dyspnea for the next 2 years till his demise.

Keywords

• aortic valve replacement
• bioprosthesis degeneration
• epic supra biological valve
• stent creep