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Updated: Feb 16, 2026
14:14
Standardized Technique of Aortic Valve Re-implantation for Valve-sparing Aortic Root Replacement
Published on: December 11, 2017
14.8K
Left ventricular outflow tract shape after aortic valve replacement with St. Jude Trifecta prosthesis
Giuseppe Barletta1, Francesco Venditti1, Pierluigi Stefano2
1Cardiology Diagnostics, Cardiac, Thoracic & Vascular Department, University Hospital Careggi, Florence, Italy.
Echocardiography (Mount Kisco, N.Y.)
|December 23, 2017
Summary
In patients with supra-annular aortic valve replacement, using 3D LVOT area (LVOTCSA) for effective prosthesis area (EOA) calculation provides more accurate results than using LVOT diameter (LVOTD) and reduces patient-prosthesis mismatch (PPM).
Area of Science:
- Cardiovascular Imaging
- Echocardiography
- Prosthetic Valve Assessment
Background:
- Effective prosthesis area (EOA) is calculated using left ventricular (LV) stroke volume (SV), typically derived from LV outflow tract diameter (LVOTD) or LV volumes (SVV).
- Evidence suggests LVOT ellipticity necessitates using 3D LVOT area (LVOTCSA) in aortic stenosis.
- This study investigates if LVOTCSA is superior to LVOTD for EOA calculation in supra-annular aortic valve replacement (AVR).
Purpose of the Study:
- To compare EOA and SV derived from LVOTD versus LVOTCSA in patients with supra-annular AVR.
- To evaluate the accuracy of EOA calculated from SVV.
- To compare patient-prosthesis mismatch (PPM) incidence across different EOA calculation methods.
Main Methods:
- A cohort of 202 patients undergoing St. Jude Trifecta AVR were assessed one year post-surgery using echocardiography.
- 3D X-plane imaging was used to compute SVV and measure LVOTCSA.
- SV was calculated from both LVOTD (SVD) and LVOTCSA (SVCSA); PPM was defined as indexed EOA <0.65 cm²/m².
Main Results:
- LVOT demonstrated significant ellipticity (index 1.17 ± 0.27).
- EOACSA (1.95 ± 0.62 cm²) was significantly larger than EOAD (1.70 ± 0.55 cm²).
- PPM incidence was higher with EOAV (15.6%) compared to EOAD (P=0.04) or EOACSA (P<0.001).
Conclusions:
- In supra-annular AVR, the LVOT remains elliptical, favoring LVOTCSA for EOA calculation.
- Using LVOTCSA results in larger EOA values and lower PPM incidence.
- EOAV may overestimate PPM.
Keywords:
aortic stenosisaortic valve prosthesisaortic valve replacementthree-dimensional transthoracic echocardiographyMore Related Videos
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