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Computed tomography angiography is not accurate in predicting surgical prosthetic aortic valve implant size
Robert Boova1, Sourodeep Banerjee1, Abul Kashem1
1Division of Cardiovascular Surgery, Department of Surgery, Lewis Katz School of Medicine-Temple University, Philadelphia, PA.
Insights
Preoperative multidetector computed tomography (MDCT) for transcatheter aortic valve replacement (TAVR) sizing is often inaccurate. MDCT measurements significantly differed from surgical implant sizes, impacting preoperative planning for aortic valve replacement.
Area of Science:
- Cardiovascular Imaging
- Surgical Planning
- Medical Device Accuracy
Background:
- Multidetector computed tomography (MDCT) is crucial for preoperative sizing in transcatheter aortic valve replacement (TAVR).
- Accurate sizing is essential for successful TAVR outcomes.
Purpose of the Study:
- To evaluate the accuracy of MDCT in predicting surgical aortic valve prosthesis size for TAVR.
- To compare MDCT-derived aortic annulus diameter with intraoperative measurements.
Main Methods:
- Retrospective analysis of 102 patients undergoing surgical aortic valve replacement (July 2012-July 2017).
- Preoperative MDCT aortic valve sizing was compared with intraoperative valve sizing.
Main Results:
- Only 40.2% of MDCT measurements accurately predicted surgical valve size.
- Implanted valves were smaller than predicted in 39.2% and larger in 20.6% of patients.
- Significant variance between MDCT and intraoperative sizing was observed, irrespective of annulus diameter.
Conclusions:
- Institutional MDCT protocols for TAVR sizing showed substantial discrepancies with surgical implant sizes.
- While no overall trend for oversizing or undersizing existed, large annuli were prone to undersizing and small annuli to oversizing.
- Findings suggest potential implications for preoperative planning in aortic valve replacement procedures.
Background:
Multidetector computed tomography is vital in preoperative sizing for transcatheter aortic valve replacement. The purpose of this study is to determine whether preoperative transcatheter aortic valve replacement multidetector computed tomography accurately predicts surgical aortic valve prosthesis size.
Methods:
Between July 2012 and July 2017, 102 patients who underwent surgical aortic valve replacement had preoperative aortic valve sizing by multidetector computed tomography. The aortic annulus diameter calculated using multidetector computed tomography was compared with intraoperative valve sizing during surgical aortic valve replacement.
Results:
Forty-one (40.2%) of the 102 patients studied had multidetector computed tomography aortic valve measurements that were accurate. Implanted valves were smaller than multidetector computed tomography calculation in 40 patients (39.2%) and were larger in 21 patients (20.6%). Multidetector computed tomography measurements remained inconsistent with intraoperative sizing regardless of aortic annulus diameter. The variance between multidetector computed tomography annulus measurements and intraoperative sizing was statistically significant.
Conclusions:
Preoperative aortic annulus measurements by our institutional transcatheter aortic valve replacement multidetector computed tomography protocol differed substantially from surgical implant size. There was no trend toward over nor under sizing for the entire cohort. However, patients with large measured annulus diameter were more likely to have a smaller valve implanted than predicted, and patients with small measured annulus diameter were more likely to have a larger valve implanted than predicted. These results may affect preoperative planning for patients undergoing aortic valve replacement.
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