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Computed Tomography Annular Dimensions: A Novel Method to Compare Prosthetic Valve Hemodynamics
G Michael Deeb1, Jeffrey J Popma2, Stanley J Chetcuti3
1Department of Cardiac Surgery, University of Michigan, Ann Arbor, Michigan.
Insights
Prosthetic heart valve sizing is inconsistent. Preoperative computed tomography (CT) measurements accurately compare valve hemodynamics, revealing transcatheter and stentless valves perform better than stented ones.
Area of Science:
- Cardiology
- Biomedical Engineering
- Surgical Innovation
Background:
- The Cardiac Surgical Societies Valve Labeling Task Force identified inconsistencies in prosthetic heart valve sizing and labeling.
- Existing methods for valve sizing and comparison lack standardization, potentially impacting patient outcomes.
Purpose of the Study:
- To compare the labeled size, internal diameter, and hemodynamics of various surgical and transcatheter prosthetic heart valves implanted in the same annular size.
- To evaluate the accuracy of preprocedural computed tomography (CT) for comparing valve performance.
Main Methods:
- Retrospective analysis of 726 surgical and 923 transcatheter valve cases.
- Patients categorized into three CT annular diameter groups: small (<23 mm), medium (23–25.9 mm), and large (≥26 mm).
- Surgical valves classified into four types: stentless porcine, standard stented bovine, wraparound stented bovine, and stented porcine.
Main Results:
- Significant differences in size, internal diameter, and hemodynamics were observed across valve types within identical CT annular size groups.
- Transcatheter valve hemodynamics were comparable to stentless valves and superior to all stented valves.
- Stented porcine valves demonstrated inferior hemodynamics compared to all other valve types.
Conclusions:
- Prosthetic heart valve sizing and labeling inconsistencies are confirmed.
- Preoperative CT annular dimensions provide the most accurate method for comparing the size, internal diameter, and hemodynamics of bioprosthetic aortic valves.
- Standardized use of CT measurements can improve the selection and comparison of prosthetic heart valves.
Background:
The Cardiac Surgical Societies Valve Labeling Task Force consensus document acknowledged inconsistent sizing and labeling of prosthetic heart valves. This study compared the labeled size, internal diameter, and hemodynamics of different surgical and transcatheter valve types implanted into the same size annulus, measured by preprocedural computed tomography (CT).
Methods:
Patients were retrospectively sorted into 3 CT annular diameter size groups: small (less than 23 mm), medium (23 to less than 26 mm), and large (26 mm or greater). Surgical valves were sorted into 4 categories based on tissue and design: (stentless porcine, standard stented bovine, wraparound stented bovine, and stented porcine). Comparisons were made within the surgical types and with a transcatheter valve. Echocardiograms were independently assessed and CTs were centrally measured.
Results:
We analyzed 726 surgical and 923 transcatheter valve paired data sets. Among the various valve types implanted into the same size CT annulus, there were significant differences regarding size, internal diameter, and hemodynamics within all 3 size groups. Root enlargement procedures occurred in 1.2% with no differences across valve types or size groups. Transcatheter valve hemodynamics were similar to stentless valves and were significantly better than all stented valves. There was no difference in hemodynamics between the 2 bovine stented valve types, and stented porcine valves were inferior to all valve types.
Conclusions:
This study documents that prosthetic heart valve sizing and labeling inconsistencies exist. Use of preoperative CT annular dimensions is the most accurate method to compare size, internal diameter, and hemodynamics of bioprosthetic aortic valves because it compares values among various valve types implanted into the same size annulus.
