Abstract
The purpose of this study was to evaluate whether bicuspid anatomy affects the discrepancy between CT-derived annular size and intraoperative size. We retrospectively analyzed annular measurements in 667 patients who underwent surgical aortic valve replacement (AVR). Preoperative CT measurements of the aortic annulus were compared to surgically implanted valve sizes. To evaluate whether the bicuspid valve affects the differences between CT annulus diameter and surgical AVR size, patients with diameter larger by > 10% (CT-Lg group) on CT, compared to surgical AVR size, were compared with those having size difference < 10% (CT-Sim group). Propensity score matching yielded 183 matched patients from each group. Bicuspid aortic valve annulus parameters significantly correlated with surgical aortic valve size (r = 0.52–0.71; for all, p < 0.01). The most representative measurements corresponded to surgical aortic valve size were area-derived diameters in tricuspid aortic valve (r = 0.69, p < 0.001) and bicuspid without raphe (r = 0.71, p < 0.001), and perimeter-derived diameter in bicuspid with raphe (r = 0.63, p < 0.001). After propensity score matching, native valve type was not different between CT-Sim and CT-Lg groups. In multivariable analysis, the difference between CT-derived diameter and surgical AVR size was affected by the operator factor and types of prosthesis. Bicuspid aortic annulus diameters measured on CT showed a significant correlation with surgical aortic valve size. The difference between CT-derived diameter and surgical AVR size is affected by operator factor and the types of prosthesis but not affected by the bicuspid valve.
Highlights
Abbreviations aortic stenosis (AS) Aortic stenosis brain natriuretic peptide (BNP) Brain natriuretic peptide computed tomography (CT) Computed tomography ejection fraction (EF) Ejection fraction geometric orifice area (GOA) Geometric orifice area left ventricular mass index (LVMI) Left ventricular mass index intra-class correlation coefficient (ICC) Intra-class correlation coefficient SAVR Surgical aortic valve replacement tissue annulus diameters (TAD) Tissue annulus diameter transcatheter aortic valve replacement (TAVR) Transcatheter aortic valve replacement
The morphologic finding in bicuspid aortic valve was associated with poor prognostic outcome with increased rates of valvular dysfunction, aortic valve and aorta surgery and the outcomes of TAVR in bicuspid aortic stenosis depended on valve morphology[7,8]
The valve sizing is based on the manufacturer-specific valve sizer during the SAVR, TAVR sizing is based on transesophageal echocardiography and electrocardiogram (ECG)-gated multidetector computed tomographic imaging
Summary
Abbreviations AS Aortic stenosis BNP Brain natriuretic peptide CT Computed tomography EF Ejection fraction GOA Geometric orifice area LVMI Left ventricular mass index ICC Intra-class correlation coefficient SAVR Surgical aortic valve replacement TAD Tissue annulus diameter TAVR Transcatheter aortic valve replacement. Aortic valvular sizing is important for both procedures, to avoid paravalvular leakage, annular rupture, ostial coronary occlusion, and other complications. The selection of an oversizing valve that fits the annulus plane is important to prevent paravalvular leakage, prosthetic valve migration, or prosthetic-patient mismatch, which can affect left ventricular mass regression and subsequent survival[2,3,4]. Aortic annular measurement methods using CT have been evaluated using diverse approaches involving the annulus diameter, area, or perimeters in the tricuspid aortic valve a natomy[9,10]; the bicuspid aortic valve was excluded in previous studies. Considering the expanding indications of TAVR in bicuspid aortic valve, aortic annular sizing in bicuspid valves should be evaluated
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