Computed Tomography Annular Dimensions: A Novel Method to Compare Prosthetic Valve Hemodynamics

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.