International Society For Minimally Invasive Cardiothoracic Surgery

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Degree Of Oversizing At Surgical Implantation Using A Sutureless Valve And Short Term Outcomes
Moritz C. Wyler von Ballmoos, Priya R. Kothapalli, Kavya Sinha, Mahesh K. Ramchandani.
Houston Methodist DeBakey Heart and Vascular Center, Houston, TX, USA.

OBJECTIVE: To assess the degree of oversizing with the Perceval sutureless valve at time of implantation and related short-term outcomes including post-implantation gradients, paravalvular leak and requirements for a permanent pacemaker. METHODS: 55 consecutive patients scheduled for elective aortic valve replacement were imaged with a cardiac CT angiography. Detailed measurements of the LVOT, aortic annulus and sinuses of Valsalva were obtained and compared against the implant size. The degree of oversizing was calculated as a percentage using the perimeter of the fully expanded valve size and the annular perimeter. Hemodynamic data from postoperative echocardiography, requirement for permanent pacemaker and mortality within 30 days were recorded. RESULTS: The sizing ranged from 33% undersizing to 36% oversizing. On average the valve/annulus perimeter ratio was 0.96. 2/55 patients had trace PVL (3.6%, 0.4-12.5%). The ratio in these 2 patients was 0.97 and 0.67 (the most undersized prosthesis). 4 patients required a permanent pacemaker (7.2%, 2-17.5%). The ratio in these 4 patients was between 0.86 and 1.36. There was no mortality at 30 days and the average post-implantation gradient very low at 7.9 mmHg (range 2-14). CONCLUSIONS: This study reports the extent of under- and oversizing of a sutureless, surgically placed aortic bioprosthetic valve that has strong similarities with a TAVR valve. In contrast to TAVR, where oversizing is pursued deliberately, our data suggest oversizing is not required with the Perceval valve. Even with slight undersizing, in reference to the annular diameter, PVL is not commonly seen. On the other hand, oversizing may result in higher pacemaker rates and higher gradients because of restricted leaflet motion.

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