An implanted valve to native annulus size ratio of 80-90% versus <80% during surgical aortic valve replacement improved 5-year survival (HR 0.752; 95% CI 0.611-0.927; P=0.008).
Cohort (n=1,519)
Yes
Does a higher ED/CTD size ratio improve postoperative hemodynamics and survival in patients undergoing surgical aortic valve replacement?
An ED/CTD size ratio >90% during surgical aortic valve replacement is associated with optimal postoperative hemodynamics and improved 5-year survival, suggesting its utility in guiding valve sizing and annular enlargement.
Effect estimate: HR 0.752 (95% CI 0.611-0.927)
p-value: p=0.008
AbstractObjective We assessed the value of using a size ratio of implanted valve opening diameter to native annular diameter to determine postoperative hemodynamics and survival after surgical aortic valve replacement. Methods In total, 1519 patients from 3 trials had a preoperative computed tomography scan. A size ratio was created using the implanted valve's Ebels' prosthetic valve−derived effective diameter (ED) and the patient's computed tomography perimeter−derived native annular diameter (CTD). Restricted cubic spline curves showed the association between size ratio and hemodynamic performance. Patients were divided into 3 ratio groups: 90%. Hemodynamic performance was evaluated yearly for 5 years. Multivariable proportional hazard regression examined the association between size ratio and 5-year survival. Results Mean valve gradient, peak velocity, effective orifice area (EOA), indexed EOA, dimensionless velocity index, and prosthesis-patient mismatch were significantly better advancing from the 80% to the 90% groups (P 90% group had a single-digit mean valve gradient, peak velocity ≤2.0 m/s, EOA ≥2.0 cm2, indexed EOA ≥1.0 cm2/m2, dimensionless velocity index ≥0.5, and no prosthesis-patient mismatch ≥85% at 1 and 5 years. Size ratio was an independent predictor of mortality with survival benefit through 5 years (80%-90% vs P = .008; >90% vs P = .05). Conclusions An ED/CTD size ratio >90% is associated with optimal postoperative hemodynamic performance and improved 5-year survival. Preoperative ED/CTD ratio provides the ideal implanted valve size and helps determine if annular enlargement is necessary.
Hamilton et al. (Fri,) conducted a cohort in surgical aortic valve replacement (n=1,519). ED/CTD size ratio (implanted valve opening diameter to native annular diameter) vs. Ratio <80% was evaluated on 5-year survival (HR 0.752, 95% CI 0.611-0.927, p=0.008). An implanted valve to native annulus size ratio of 80-90% versus <80% during surgical aortic valve replacement improved 5-year survival (HR 0.752; 95% CI 0.611-0.927; P=0.008).