Key result
Preoperative MDCT perimeter-derived diameter predicts Perceval valve size with ~70% accuracy using K-means.
Why the study?
The study was designed to evaluate the accuracy of preoperative multidetector computed tomography measurements in predicting the appropriate Perceval prosthesis size and develop a sizing chart to assist surgeons.
Do preoperative MDCT measurements accurately predict the appropriate Perceval valve size in patients undergoing aortic valve replacement?
Observational (n=338)
Yes
Do preoperative MDCT measurements accurately predict the appropriate Perceval valve size in patients undergoing aortic valve replacement?
Preoperative MDCT measurements, specifically perimeter-derived diameter using K-means clustering, provide moderate predictive accuracy (almost 70%) for Perceval valve sizing, though intraoperative assessment remains essential.
OBJECTIVE: This multicenter study evaluates the accuracy of preoperative multidetector computed tomography (MDCT) measurements in predicting the appropriate Perceval (CORCYM Srl, Milan, Italy) prosthesis size, developing a chart to support surgeons in identifying the correct valve size. METHODS: A multicenter retrospective study was conducted across 15 centers in 10 different countries. Inclusion criteria included preoperative MDCT imaging, meeting standardized technical specifications, and early postoperative clinical and hemodynamic outcomes, meeting the expected outcomes of a correctly sized valve. The K-means and receiver operating characteristic (ROC) analysis were applied to evaluate the sizing chart on 70% of the population, and their accuracy was verified on the remaining 30%. RESULTS: There were 338 patients (mean age = 72.8 ± 7.9 years, 50.6% male) analyzed for this study, with a distribution of implanted bioprosthetic valve sizes of small in 21.6%, medium in 39.6%, large in 26.0%, and extra-large in 12.7%. The perimeter-derived diameter was found to be the MDCT-derived anatomical parameter with best overall correlation with the prosthesis size, and the K-means method outperformed the ROC curve-based classification, with an accuracy of prediction at almost 70%. CONCLUSIONS: The analysis of CT-based annular measurements as a predictive tool for Perceval valve sizing represents a meaningful step forward in contemporary cardiac surgery. In our retrospective, multicenter, real-world cohort, preoperative aortic annulus dimensions obtained via MDCT showed a moderate predictive accuracy for tricuspid aortic valves, and intraoperative assessment remains essential. Future larger studies, improved MDCT quality, and artificial intelligence tools may help refine and improve predictive performance, also in bicuspid anatomies.
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Ramchandani et al. (2026) conducted an observational in Aortic valve disease requiring Perceval valve implantation (n=338). Preoperative multidetector computed tomography (MDCT) measurements was evaluated on Accuracy of predicting the appropriate Perceval prosthesis size. Preoperative MDCT-derived perimeter-derived diameter predicted the appropriate Perceval valve size with an accuracy of almost 70% using the K-means method.
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