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OBJECTIVE: Sutureless prostheses facilitate aortic valve replacement (AVR) through a right anterior minithoracotomy (RAMT). However, correct valve sizing remains a crucial step of this procedure. We analysed contrast-enhanced preoperative multidetector row computed tomography (cMDCT) for aortic annulus measurement and valve size prediction in patients undergoing AVR.
METHODS: From January 2011 to September 2013, 201 patients underwent aortic valve surgery as sole procedure with implantation of Sorin Perceval S (SPS) in RAMT. Inclusion criteria for this study was presence of preoperative cMDCT and echocardiography. cMDCT was used to measure the aortic annulus as the diameter derived either from the area (aD) or the circumference (cD) of the virtual basal ring, left ventricular outflow tract (LVOT) diamters either from the area (aLVOT) or the circumference (cLVOT). cMDCT was reviewed with single operator who were blind implanted valve size. Aortic annular diameter and LVOT diameter was retrieved from echocardiographic records. Predictive models were build based on ordered logistic regression with single covariates.
RESULTS: We identified 54 patients who had preoperative cMDCT. Seven patients received a S, 21 received a M and 26 received a L size SPS. Mean age of the patients at the time of intervention was 76.3 ± 6.8 years, mean logistic EuroScore 10.4 ± 8.7 %. Echocardiographic measurements showed lower accuracy to predict valve size compered to cMDCT measurements. Echocardiographic LVOT measurements was 61.1 % to predict the valve size whereas annulus measurement was 53.7 %. aLVOT from cMDCT had around 63 % and cLVOT had 64.8 % predictive accuracy. cD had highest accuracy to predict the valve size (81.5 %, AUC 0.77) following by aD having accuracy around 79.6 %. Multivariate models fail to increase the predictive accuracy. Classification tree models after pruning with 4 nodes increased the accuracy (83.3 %) and it was easy to interred and possibly easy to implement for clinical use.
CONCLUSIONS: cMDCT measured estimates seem to have higher predictive value for valve size determination in patients undergoing RAMT with SPS. In clinical conditions cMDCT is preferable over echocardiography for precise aortic annulus diameter estimation.