Abstract
BackgroundPatient-prosthesis mismatch (PPM) is a major concern in aortic valve replacement (AVR) and leads to perioperative morbidity and rehospitalization. Predicting aortic annulus diameter pre-procedurally is crucial to managing patients with high-risk of PPM.ObjectivesTo compare preoperative measurements of aortic annulus from echocardiography and CT scan with surgical sizing and develop an imaging-based algorithm to predict PPM.MethodsFrom January 2017 to December 2020, patients underwent AVR at a teaching hospital were examined. The relationship between imaging measurements with operative values was assesed using scatter plots and Pearson’s correlation coefficient. Univariable linear regression was then used to build the predictive model.ResultsA total of 144 patients underwent AVR during the study period. Suture types and surgical approaches were not significantly associated with prosthesis size. CT scan-based measurements showed strong correlation with prosthesis size: mean diameter (R = 0.79), perimeter-derived diameter (R = 0.76), and area-derived diameter (R = 0.75). Mechanical valve and tissue valve shared similar correlation coefficients. Prosthesis size predictive models based on CT scan were 12.89 + 0.335 × d for mean diameter, 13.275 + 0.315 × d for perimeter-derived diameter and 13.626 + 0.309 × d for area-derived diameter.ConclusionsPreoperative CT scan measurements are a reliable predictor of aortic prosthesis size. Transthoracic echocardiography is a possible alternative, though it is highly performer-dependent and unable to represent the aortic annulus fully. Together, these two imaging modalities can be used to quantitatively anticipate PPM preoperatively.
Highlights
Aortic valve replacement (AVR) remains the gold standard for patients with valvular lesions like aortic stenosis
Preoperative computed tomography (CT) scan measurements are a reliable predictor of aortic prosthesis size
We found no significant differences in the durations of cardiopulmonary bypass, cross-clamp, mechanical ventilation and Intensive care unit (ICU) stay among three surgical techniques
Summary
Aortic valve replacement (AVR) remains the gold standard for patients with valvular lesions like aortic stenosis. A major complication following AVR is patient-prosthesis mismatch (PPM), a nonstructural dysfunction. While the negative impact of PPM in the early recovery period is controversial, it generally increases perioperative morbidity and rehospitalization due to heart failure and lack of left ventricular mass regression, and eventually long-term mortality [2, 3]. Vo et al J Cardiothorac Surg (2021) 16:221 to increase the likelihood of PPM, including female sex, younger age, high body surface area (BSA), left ventricular end systolic diameter, aortic root dimension [4], hypertension, diabetes, renal failure, and utilization of bioprothesis [5]. Patient-prosthesis mismatch (PPM) is a major concern in aortic valve replacement (AVR) and leads to perioperative morbidity and rehospitalization. Predicting aortic annulus diameter pre-procedurally is crucial to managing patients with high-risk of PPM
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