A Case of Early Re-aortic Valve Replacement due to Progressive Stent Creep

Q: What is the clinical evidence from this study?

Study design: Case Report. Population: Bioprosthetic aortic valve dysfunction due to stent creep and pannus overgrowth (n=1). Intervention: Redo aortic valve replacement (Inspiris 19 mm) with Y-incision annular enlargement and concomitant CABG. Primary outcome: Postoperative stent creep ratio on 3D cardiac CT.

Q: What does this research mean for the field?

Redo aortic valve replacement combined with Y-incision annular enlargement resolves bioprosthetic valve dysfunction caused by progressive stent creep and pannus overgrowth, restoring normal hemodynamics. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Mamoru Orii; Akihiko Yamauchi; Toshiya Fukushima; Hiroki Moriuchi; Takayuki Fujii; Kohei Narayama; Junzo Inamura; Nobuhiro Shimabukuro

doi:10.4326/jjcvs.55.215

September 15, 2026Japanese Journal of Cardiovascular SurgeryOpen Access

A Case of Early Re-aortic Valve Replacement due to Progressive Stent Creep

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Key result

Redo AVR with Y-incision annular enlargement resolves bioprosthetic stent creep, cutting mean gradients by ~26 mmHg.

n=1

Why the study?

This report describes the surgical management of early prosthetic aortic valve dysfunction caused by progressive stent creep secondary to marked connective tissue and pannus proliferation along the sinus of Valsalva wall.

Key Points

To describe the surgical management of early bioprosthetic aortic valve failure resulting from severe stent creep and pannus overgrowth.
Evaluated an 82-year-old woman presenting with bioprosthetic stenosis (peak velocity 4.6 m/s, mean gradient 40 mmHg) 7 years after receiving a 19 mm Magna Ease bioprosthesis.
Conducted a redo sternotomy, transected the embedded stent post to explant the valve, enlarged the annulus via the Y-incision technique, and implanted a 19 mm Inspiris valve.
Performed concomitant coronary artery bypass grafting to the right coronary artery using a saphenous vein graft due to right ventricular dysfunction upon cross-clamp release.
Cardiac CT confirmed preoperative stent creep with an area ratio of 0.74 (56.5 mm2/76.2 mm2), which improved to 0.99 (77.9 mm2/78.5 mm2) postoperatively.
Total operation time was 7 hours and 53 minutes; following permanent pacemaker implantation on day 23, the patient was discharged home on postoperative day 38.

Study Design

Type

Case Report (n=1)

Multicenter

No

Structured PICO

P

Population

An 82-year-old woman in Japan with early bioprosthetic aortic valve dysfunction due to progressive stent creep and sinus of Valsalva pannus overgrowth 7 years after initial valve replacement, followed for 2 months post-reoperation.

I

Intervention

Redo median sternotomy, explantation of the existing bioprosthesis by transecting and disrupting the stent post between the left and non-coronary cusps, aortic root enlargement using the Y-incision technique with a Dacron patch, re-aortic valve replacement with a 19 mm bioprosthetic valve in the supra-annular position, and concomitant coronary artery bypass grafting to the right coronary artery (#2) using a great saphenous vein graft.

O

Outcome

Resolution of prosthetic valve dysfunction and improvement in hemodynamic parameters and stent creep ratio on postoperative echocardiography and 3D-CT up to 2 months postoperatively.surrogate

This case report demonstrates that early bioprosthetic aortic valve dysfunction caused by progressive stent creep and extensive sinus of Valsalva pannus can be successfully treated with stent post transection for valve explantation followed by Y-incision annular enlargement and redo surgical aortic valve replacement.

Limitations

Single case report
No pathological evaluation of the explanted valve was performed because the prosthesis was transected and disrupted during explantation
Stent creep ratio was measured using preoperative and postoperative 3D-CT rather than direct measurement of the explanted valve or 3D-TEE, making the 0.74 value a reference only
Lack of prior published evidence verifying whether annular enlargement techniques prevent future stent creep
Single case report.
Pathological evaluation of the explanted valve was not performed because the valve was transected and disrupted during explantation.
Stent creep ratio of 0.74 was measured using preoperative and postoperative 3D-CT rather than direct measurement of the explanted valve or 3D-TEE as in prior studies, making it a reference value only.
No prior reports were found verifying whether annular enlargement techniques are actually useful in preventing future stent creep.

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Implication

May facilitate redo AVR for stent creep; extends technical case descriptions but leaves open durability and generalizability.

Abstract

Valsalva壁の著明な結合組織・パンヌス増生に伴うstent creepによる早期大動脈弁位人工弁機能不全を経験したため報告する．2018年にMagna Ease TFX 19 mm（Edwards Lifesciences, Irvine, CA）による生体弁大動脈弁置換術，僧帽弁形成術，三尖弁形成術，MAZE手術，左心耳切除術が行われた．2025年7月経胸壁心臓超音波検査にて人工弁弁尖の可動性は保たれているにもかかわらず，大動脈弁最大血流速度4.6 m/s，平均圧較差40 mmHgと上昇しProsthesis-Patient Mismatchと診断され手術方針となった．全身麻酔下に胸骨再正中切開が行われた．上行大動脈に送血管，上大静脈・下大静脈に脱血管を留置し人工心肺を確立した．上行大動脈にDLP 14 G （Medtronic, Minneapolis, USA）を留置したのち，右心房切開し冠静脈洞にRetro TH 12 Fr（Fuji Systems, Tokyo, Japan）を直視下に留置した．大動脈遮断後に初回順行性冠灌流にて心停止を得た．以降持続の逆行性冠灌流にて心停止を維持した．術中所見では大動脈弁位人工弁の弁尖可動性は保たれており，人工弁内にはパンヌス形成は乏しかったが，大動脈基部壁の増生した結合織にステントポストが埋没してほぼ目視できない状態だった．人工弁の弁尖を切除したのち，左冠尖－無冠尖間のステントポストを離断・破壊し人工弁を摘除した．大動脈基部がパンヌスにより狭小化していたため，大動脈壁を切開しY-incision technique（Hemashield patch（Getinge, Gothenburg, SE））による弁輪拡大を行った．その後，Inspiris 19 mm（Edwards Lifesciences,Irvine, CA）による大動脈弁置換術を行った．右冠動脈入口部周囲にも高度に結合組織が増生しており，右冠動脈のcoronary heightも低位だった．大動脈遮断解除後に右心機能の低下を認め右冠動脈狭窄が疑われた．そのため大伏在静脈を採取して右冠動脈2番にバイパスを行った．手術時間は7時間53分，術場抜管し集中治療室に入室された．術後23日目にペースメーカー留置を要したが，そのほか経過は良好で術後38日目に自宅退院された．術前心臓CT検査にてstent creep ratio 0.74（56.5 mm2/76.2 mm2）と低下しておりstent creepの所見を認めた．なお術後CT検査ではstent creep ratio 0.99 （77.9 mm2/78.5 mm2））と改善を認めた．Stent creepによる人工弁機能不全に対して，人工弁を離断・破壊したのち摘出しY incision techniqueによる弁輪拡大を行い良好な結果を残したため報告する．

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Cite This Study

Orii et al. (2026) conducted a case report in Bioprosthetic aortic valve dysfunction due to stent creep and pannus overgrowth (n=1). Redo aortic valve replacement (Inspiris 19 mm) with Y-incision annular enlargement and concomitant CABG was evaluated on Postoperative stent creep ratio on 3D cardiac CT. Redo aortic valve replacement with Y-incision annular enlargement improved the stent creep ratio from 0.74 to 0.99 and reduced the mean pressure gradient from 40 to 13.6 mmHg at 2 months.

synapsesocial.com/papers/6af0e999de503f3774140a35 https://doi.org/10.4326/jjcvs.55.215

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A Case of Early Re-aortic Valve Replacement due to Progressive Stent Creep

Key Points

Study Design

Structured PICO

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

A Case of Early Re-aortic Valve Replacement due to Progressive Stent Creep

Key Points

Study Design

Structured PICO

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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