Comparison of preoperative aortic valve imaging techniques for patients with aortic insufficiency undergoing aortic valve repair surgery

Objective To report the accuracy of preoperative 4-dimensional cardiac computed tomography angiogram (CTA), real-time 3-dimensional transesophageal echocardiography (TEE) and intraoperative techniques in aortic valve (AV) measurement and phenotype determination in patients undergoing surgery for aortic insufficiency and/or root aneurysm. Methods This is a prospective, observational study of preoperative AV imaging for AV repair surgery. Twenty-two patients were accrued over 12 months. Preoperative TEE and CTA were obtained and measurements provided by dedicated imaging cardiologists. Intraoperative measurements were obtained from the arrested heart and reported by the surgeon before repair. Intraoperative assessment was considered the gold standard of height measurements, with CTA being the standard assessment for commissural orientation. Correlation coefficients were used to describe agreement of measurements. Results Baseline characteristics and assessment of phenotype and measurement of commissural orientation, geometric height and commissural heights are reported. TEE ( κ = 0.833; P < .01) and CTA ( κ = 0.729; P < .01) both agreed with intraoperative assessment of AV phenotype. TEE appeared more accurate than intraoperative measurement at predicting commissural orientation ( r s = 0.79; P < .01 vs r s = 0.58; P = .01). CTA and TEE were unlikely to predict and measured shorter than intraoperative geometric height measurement. Measurements of commissural heights by CTA did not agree with and were shorter than intraoperative measurement. Conclusions TEE and CTA both appear accurate in predicting the AV phenotype identified intraoperatively. CTA and TEE predicted shorter heights than intraoperative measurement.