The Use of Root Computed Tomography Angiography as Morphological Evaluation for Aortic Valve Repair and Valve Sparing Aortic Root Replacement

Abstract Objectives Root computed tomography angiography is a helpful imaging tool for designing aortic valve repair and valve-sparing surgery. It remains unclear whether this method produces reliable measurements in virtual basal ring and geometric height. We aimed to evaluate the accuracy in a large patients’ sample. Methods The virtual basal ring and geometric height were evaluated by computed tomography and intraoperative measurements, with the virtual basal ring additionally assessed by transthoracic echocardiography (TTE). The consistency was evaluated with the Bland-Altman method. Results A total of 238 patients with good quality image data were included. The virtual basal ring was 26.42(4.23) mm on TTE, 28.83(4.50) mm on root computed tomography angiography, and 28.06(4.00) mm on intraoperatively(ICC: 0.96 versus 0.98). The geometric height of the left tricuspid cusp, left bicuspid cusp in 2 sinuses, and non-fused bicuspid cusp with right non-fusion was 19.28(2.24) mm on computed tomography versus 19.24(2.20) mm intraoperatively (ICC = 0.97). The geometric height of the right tricuspid cusp and the right bicuspid cusp with 2 sinuses was 19.06(2.41) mm vs 19.11(2.50) mm (ICC = 0.97). The geometric height of the non-coronary tricuspid cusp and the non-fused bicuspid cusp with left-right fusion was 20.54(2.63) mm vs 20.84(2.77) mm (ICC = 0.98). Conclusions The virtual basal ring and geometric height can be accurately measured using root computed tomography angiography. For patients potentially eligible for aortic valve repair and valve-sparing aortic root replacement, it may provide important information to plan the surgical strategy.