Key result
Preoperative CT scan measurements of the aortic annulus showed a strong correlation with actual implanted prosthesis size (R = 0.79 for mean diameter), outperforming transthoracic echocardiography.
Why the study?
Patient-prosthesis mismatch is a major concern in AVR leading to perioperative morbidity and rehospitalization, making pre-procedural prediction of aortic annulus diameter crucial.
Does preoperative CT scan measurement predict actual implanted aortic prosthesis size better than TTE in patients undergoing aortic valve replacement?
Cohort (n=144)
No
Does preoperative CT scan measurement predict actual implanted aortic prosthesis size better than TTE in patients undergoing aortic valve replacement?
Effect estimate: R = 0.79
Preoperative CT scan measurements of the aortic annulus strongly correlate with actual implanted prosthesis size and can be used to quantitatively predict sizing to prevent patient-prosthesis mismatch.
CT measurements may better predict prosthesis size than echocardiography; leaves open whether an imaging algorithm reduces PPM.
BACKGROUND: 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. OBJECTIVES: To compare preoperative measurements of aortic annulus from echocardiography and CT scan with surgical sizing and develop an imaging-based algorithm to predict PPM. METHODS: From 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. RESULTS: A 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. CONCLUSIONS: Preoperative 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.
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Vo et al. (2021) conducted a cohort in Aortic valve lesions requiring replacement (n=144). Preoperative CT scan measurements vs. Transthoracic echocardiography (TTE) measurements was evaluated on Correlation between imaging measurements and actual implanted prosthesis size (R = 0.79). Preoperative CT scan measurements of the aortic annulus showed a strong correlation with actual implanted prosthesis size (R = 0.79 for mean diameter), outperforming transthoracic echocardiography.
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