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Aortic Valve Annular Sizing: Intraoperative Assessment Versus Preoperative Multidetector Computed Tomography
Isaac George1, Laura C Guglielmetti2, Nicolas Bettinger2
1From the Division of Cardiothoracic Surgery, New York Presbyterian Hospital - College of Physicians and Surgeons of Columbia University, New York, NY (I.G., A.M., C.W., N.K., C.S.); Division of Thoracic Surgery, University Hospital of Zurich, Switzerland (L.C.G.); Division of Cardiology, New York Presbyterian Hospital - College of Physicians and Surgeons of Columbia University, NY (N.B., R.H., S.K., M.L., M.A.B., O.K.K.); Division of Cardiothoracic Surgery, Guys and St. Thomas Hospital Trust, London, United Kingdom (V.B.); and Department of Cardiothoracic Surgery, New York University, NY (M.W.). ig2006@cumc.columbia.edu.
Direct intraoperative aortic valve sizing is more accurate than multidetector computerized tomographic (MDCT) imaging. MDCT sizing led to undersized valves in 41% of patients, impacting geometric orifice area (GOA) calculations.
Area of Science:
- Cardiovascular Surgery
- Medical Imaging
- Biomedical Engineering
Background:
- Accurate aortic valve sizing is crucial for successful aortic valve replacement.
- Current sizing relies on preoperative imaging, potentially leading to discrepancies.
Purpose of the Study:
- To compare aortic annular diameters measured by direct intraoperative assessment versus multidetector computerized tomographic (MDCT) imaging.
- To evaluate the impact of sizing discrepancies on valve selection and geometric orifice area (GOA).
Main Methods:
- Retrospective analysis of 78 patients undergoing surgical aortic valve replacement for severe aortic stenosis.
- Comparison of MDCT-derived theoretical valve size with intraoperatively implanted surgical valve size.
- Calculation of geometric orifice areas (GOA) to quantify sizing differences.
Main Results:
- MDCT-based sizing resulted in undersized valves in 41% of patients.
- Implanted valves were smaller relative to MDCT sizing, with GOA differences ranging from -22% to +25%.
- Transcatheter aortic valve replacement (TAVR) sizing based on MDCT showed potential GOA increases of 14.6% to 40.6% compared to intraoperative findings.
Conclusions:
- Preoperative MDCT measurements significantly differ from direct intraoperative aortic annulus assessment.
- Intraoperative sizing is essential for accurate valve selection in aortic valve replacement.
- Discrepancies in MDCT sizing can lead to undersized surgical valves and affect potential GOA in TAVR.
