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. 2021 Oct 25;11(1):21005.
doi: 10.1038/s41598-021-00406-3.

Aortic annulus sizing in bicuspid and tricuspid aortic valves using CT in patients with surgical aortic valve replacement

Jooae Choe #  1 , Hyun Jung Koo #  1 , Joon-Won Kang  1 , Joon Bum Kim  2 , Hee Jun Kang  3 , Dong Hyun Yang  4
Affiliations

Aortic annulus sizing in bicuspid and tricuspid aortic valves using CT in patients with surgical aortic valve replacement

Jooae Choe et al. Sci Rep. .

Abstract

The purpose of this study was to evaluate whether bicuspid anatomy affects the discrepancy between CT-derived annular size and intraoperative size. We retrospectively analyzed annular measurements in 667 patients who underwent surgical aortic valve replacement (AVR). Preoperative CT measurements of the aortic annulus were compared to surgically implanted valve sizes. To evaluate whether the bicuspid valve affects the differences between CT annulus diameter and surgical AVR size, patients with diameter larger by > 10% (CT-Lg group) on CT, compared to surgical AVR size, were compared with those having size difference < 10% (CT-Sim group). Propensity score matching yielded 183 matched patients from each group. Bicuspid aortic valve annulus parameters significantly correlated with surgical aortic valve size (r = 0.52-0.71; for all, p < 0.01). The most representative measurements corresponded to surgical aortic valve size were area-derived diameters in tricuspid aortic valve (r = 0.69, p < 0.001) and bicuspid without raphe (r = 0.71, p < 0.001), and perimeter-derived diameter in bicuspid with raphe (r = 0.63, p < 0.001). After propensity score matching, native valve type was not different between CT-Sim and CT-Lg groups. In multivariable analysis, the difference between CT-derived diameter and surgical AVR size was affected by the operator factor and types of prosthesis. Bicuspid aortic annulus diameters measured on CT showed a significant correlation with surgical aortic valve size. The difference between CT-derived diameter and surgical AVR size is affected by operator factor and the types of prosthesis but not affected by the bicuspid valve.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Figure 1
Figure 1
Measurement of virtual ring of aortic annulus on CT. In tricuspid or bicuspid aortic valve with raphe, descending from the sinus Valsalva to left ventricular outflow track, the hinge point of each individual aortic valve cusp is identified to establish the plane of the annulus. Virtual ring of aortic annulus is selected at the plane of the circumferential ring at the basal attachment points of the three aortic cusps. In bicuspid valve without raphe, the plane and level of virtual ring of aortic annulus is determined when the smallest cross-sectional area is drawn, by drawing a line between both basal ends of the cusps and turning the plane 360 around those two points.
Figure 2
Figure 2
Scatter plot to demonstrate the distribution of area-derived annular diameter measured on CT and tissue annular diameter of surgical aortic valve replacement (SAVR).
Figure 3
Figure 3
Comparison of GOA measured in surgical aortic valve replacement (SAVR) and CT-derived geometric orifice area (SAVR-CT) according to the native valve types. GOA, geometric orifice area; SAVR, surgical aortic valve replacement.
See this image and copyright information in PMC

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References

    1. Pibarot P, et al. Association of paravalvular regurgitation with 1-year outcomes after transcatheter aortic valve replacement with the SAPIEN 3 valve. JAMA Cardiol. 2017;2:1208–1216. doi: 10.1001/jamacardio.2017.3425. - DOI - PMC - PubMed
    1. Blanke P, et al. Computed tomography-based oversizing degrees and incidence of paravalvular regurgitation of a new generation transcatheter heart valve. JACC Cardiovasc. Interv. 2017;10:810–820. doi: 10.1016/j.jcin.2017.02.021. - DOI - PubMed
    1. Pibarot P, et al. Incidence and sequelae of prosthesis-patient mismatch in transcatheter versus surgical valve replacement in high-risk patients with severe aortic stenosis: a PARTNER trial cohort—a analysis. J. Am. Coll. Cardiol. 2014;64:1323–1334. doi: 10.1016/j.jacc.2014.06.1195. - DOI - PMC - PubMed
    1. Willson AB, et al. 3-dimensional aortic annular assessment by multidetector computed tomography predicts moderate or severe paravalvular regurgitation after transcatheter aortic valve replacement: a multicenter retrospective analysis. J. Am. Coll. Cardiol. 2012;59:1287–1294. doi: 10.1016/j.jacc.2011.12.015. - DOI - PubMed
    1. Jilaihawi H, et al. Cross-sectional computed tomographic assessment improves accuracy of aortic annular sizing for transcatheter aortic valve replacement and reduces the incidence of paravalvular aortic regurgitation. J. Am. Coll. Cardiol. 2012;59:1275–1286. doi: 10.1016/j.jacc.2011.11.045. - DOI - PubMed

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