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Updated: Oct 28, 2026
Standardized Technique of Aortic Valve Re-implantation for Valve-sparing Aortic Root Replacement
Published on: December 11, 2017
Quantification of Aortic Cusp Parameters Using Computed Tomography in Valve-Sparing Aortic Root Replacement Surgery:
Hong Rae Kim1, Dong Hyun Yang2, Joon Bum Kim3
1Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Purpose:
Determining the feasibility of valve-sparing aortic root replacement (VSRR) requires accurate preoperative assessment of aortic valve cusp geometry. However, the reliability of computed tomography (CT) for measuring cusp parameters remains unclear. This study evaluated the agreement between CT-derived cusp measurements and intraoperative measurements and explored the potential of CT-based cusp asymmetry to predict intraoperative cusp plication.
Materials And Methods:
In this prospective study, 32 consecutive patients undergoing VSRR with the reimplantation technique were enrolled. Preoperative CT was used to measure cusp free margin length and geometric height. Agreement between CT-derived and intraoperative measurements was assessed using Bland-Altman analysis and intraclass correlation coefficients (ICCs). An exploratory analysis evaluated whether CT-derived cusp asymmetry predicted the need for intraoperative cusp plication.
Results:
CT measurements demonstrated good agreement with intraoperative measurements for cusp free margin length (ICC 0.80-0.87). In contrast, geometric height showed only moderate agreement (ICC 0.44-0.69). Exploratory receiver operating characteristic analysis demonstrated moderate discriminative ability of CT-derived cusp asymmetry for predicting intraoperative cusp plication (area under the curve, 0.71; 95% confidence interval, 0.49-0.91), although the association did not reach statistical significance (p=0.06). Postoperative echocardiography demonstrated none-to-mild aortic insufficiency in 96.9% of patients.
Conclusion:
Preoperative CT demonstrated good agreement with intraoperative measurements for cusp free margin length in tricuspid valves, although the absolute limits of agreement were wide. CT-based quantification of cusp asymmetry may provide additional information for preoperative surgical planning; however, its association with intraoperative cusp plication remains exploratory and requires validation in larger studies.
Clinical Research Information Service (Cris) Registration Number:
KCT0006180.
