Preoperative Image-guided Sizing For Surgical Aortic Valve Replacement With Sutureless Valves
Moritz C. Wyler von Ballmoos, Omar Jeroudi, John Mahmarian, Mahesh K. Ramchandani.
Houston Methodist DeBakey Heart and Vascular Center, Houston, TX, USA.
Background: Surgical aortic valve replacement (SAVR) increasingly competes with transcatheter valve replacement (TAVR). The Perceval sutureless valve has become popular especially for minimally-invasive SAVR but appropriate sizing is critical to obtain low gradients while avoiding leaks and compression of the conduction system. Intraoperative sizing is different from other surgically implanted valves and more comparable to TAVR. Objective: To study the correlation of precise preoperative measurements of the left ventricular outflow tract, aortic annulus and implanted valve size in patients undergoing SAVR with Perceval. Methods & Results: 25 consecutive patients were studied using gated cardiac CT-angiography (CCTA) prior to SAVR. Demographic, anthropometric and CCTA measurements (Table 1) were recorded prior to surgery and patients underwent valve replacement using the Perceval sizers and bioprosthesis (S: n=2; M: n=11; L: n=5; XL: n=7). All CCTA measurements showed a correlation with implanted valve size (R2 0.63-0.73, all p<.003). LVOT size (R2 0.72) and aortic annular perimeter (R2 0.71) showed the strongest correlation with implanted valve size. Patients receiving a small or medium valve had almost identical CCTA measurements but in the vast majority received the larger prosthesis (11/13). Conclusions: Similar to TAVR, sizing of the Perceval shows the best correlation with measurements of the LVOT and annular perimeter. A substantial proportion of patients had a larger prosthesis implanted than CCTA measurement would have suggested. Ongoing enrollment of patients in this cohort is currently underway with the goal to establish an algorithm to predict appropriate prosthesis selection prior to Perceval SAVR as well as identification of patients that will get a larger than anticipated prosthesis during Perceval SAVR. This information may be valuable when weighing the options of SAVR versus TAVR.
| Implanted Valve | LVOT (mm) | Perimeter (mm) | Min Diameter (mm) | Max Diameter (mm) |
| Small (19-21mm) | 19.5 (19-20) | 68.5 (64-73) | 19.5 (18-21) | 24.4 (22-27) |
| Medium (23-25mm) | 19.4 (17-21) | 72.9 (52-91) | 19.4 (15-27) | 26.0 (17-31) |
| Large (25-27mm) | 21.3 (21-22) | 82.6 (76-93) | 22.4 (20-24) | 29.0 (24-34) |
| XLarge (27-29mm) | 22.6 (21-24) | 92.3 (84-104) | 25.3 (21-29) | 32.1 (29-38) |
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