Aortic prosthetic size predictor in aortic valve replacement (original) (raw)
Related papers
Heart, 1985
In 43 patients who underwent aortic valve replacement for aortic stenosis with or without regurgitation the accuracy of preoperative left ventricular angiography, parasternal long axis cross sectional echocardiography of left ventricular outflow tract and proximal ascending aorta, and M mode echocardiography of aortic root in predicting aortic root size and thereby prosthesis size was compared. Cross sectional echocardiographic measurements and angiographic measurements of aortic root correlated well with prosthesis size, with over two thirds of the indirect measurements being within 2 mm of prosthesis diameter. M mode echocardiography did not yield useful predictive information. Non-invasive preoperative evaluation of patients likely to require aortic valve replacement may be usefully extended to include aortic root dimensions measured by cross sectional echocardiography.
… Precise determination of the size of aortic annulus is very important for the preoperative evaluation before aortic valve replacement. Objectives: To determine the preoperative prosthesis size using echocardiography in patients undergoing aortic valve replacement. Study Design: Prospective observational study. Setting: Ch. Pervaiz Elahi Institute of Cardiology (CPEIC) Multan. Period: January 2013 to October 2014. Methods: (100 patients) Aortic annulus sizes were measured with TTE one week before surgery and with the help of sizer per-operatively. The data was analyzed by using SPSS V16. Quantitative variables were analyzed using mean and standard deviation and percentages were used for qualitative variables. Dependent sample t test was used to see accuracy of TTE in measuring aortic annulus size. Results: Out of hundred patients, 84(84%) were male. Mean age of the patients was 33.77 +13.17 years. 51% patients underwent isolated Aortic valve replacement; redo-operations were done only in 4% patients. In 96% patient's mechanical prosthesis was used and in 4% patient's boiprosthesis was used for valve replacement. We found no significant difference in Aortic annulus measured pre-operatively with the TTE (23.54+ 3.54) and measured per-operative with the sizer (23.96+3.36) with highly insignificant p-value 0.58.Aortic annulus size was almost same measured by these two techniques. Conclusion: Aortic annulus size measured with TTE helps to arrange the optimum size prosthesis before aortic valve replacement surgery.
2021
Introduction: Proper sizing of the aortic annulus is vital in selecting the most appropriate valve size during open aortic valve replacement. The aortic annulus diameter measured by preoperative transthoracic echocardiography or CT scan, often yields different values than the prosthetic valve annulus measured intraoperatively and the same has been implicated in frequent paravalvular leakage, PPM, thromboembolism and endocarditis. In our study we evaluated the accuracy of valve sizing obtained by preoperative CT scan and echocardiography by comparing these measurements with direct intraoperative sizing. Methods: Total 100 patients undergone standard open surgical valve replacement in our institution between January 2019 to December 2019 were retrospectively analyzed. Their maximum aortic annulus diameter determined by preoperative CT scan and echocardiography were individually compared and correlated statistically with the implanted valve size. Results: The systolic annulus diameter ...
Heart, 2007
Background: To predict the occurrence of valve prosthesis-patient mismatch (VP-PM) after aortic valve replacement (AVR), the surgeon needs to estimate the postoperative effective orifice area index (EOAI). Aim: To compare different methods of predicting VP-PM. Methods: The effective orifice area (EOA) of 383 patients who had undergone AVR between July 2000 and January 2005 with various aortic valve prostheses was obtained echocardiographically 6 months after the operation. We tested the efficacy of (1) EOAI calculated from the echo data obtained in our own laboratory, (2) indexed geometric orifice area, (3) EOAI estimated from charts provided by prosthesis manufacturers (which are based either on in vitro or on echo data) and (4) EOAI estimated from reference echo data published in the literature to predict VP-PM. Results: Sensitivity and specificity to predict VP-PM were 53% and 83% (method 1), 80% and 53% (charts based on echo data, parts of method 3) and 71% and 67% (method 4) using reference data derived from echocardiographic examinations. The sensitivity of method 2 and of charts based on in vitro data (parts of method 3) to predict VP-PM was 0-17%. The incidence of severe VP-PM could be reduced from 8.7% to 0.8% after the introduction of the systematic estimation of the EOAI at the time of operation (p = 0.003, method 1). Conclusions: The best method of predicting VP-PM is the use of mean (SD) EOAs derived from echocardiographic examinations, whereas the use of in vitro data or the geometric orifice area is unreliable. After the surgeon's anticipation of VP-PM prior to AVR, the incidence of VP-PM could be reduced.
The Impact of Annular Size on Outcomes After Surgical or Transcatheter Aortic Valve Replacement
The Annals of thoracic surgery, 2018
This analysis evaluates the relationship of annular size to hemodynamics and the incidence of prosthesis-patient mismatch (PPM) in surgical aortic valve replacement (SAVR) and transcatheter aortic valve replacement (TAVR) patients. The CoreValve US Pivotal High Risk Trial, described previously, compared TAVR using a self-expanding valve with SAVR. Multislice computed tomography was used to categorize TAVR and SAVR subjects according to annular perimeter-derived diameter: large (≥26 mm), medium (23 to <26 mm), and small (<23 mm). Hemodynamics, PPM, and clinical outcomes were assessed. At all postprocedure visits, mean gradients were significantly lower for TAVR compared with SAVR in small and medium size annuli (p < 0.001). Annular size was significantly associated with mean gradient after SAVR, with small annuli having the highest gradients (p < 0.05 at all timepoints); gradients were similar across all annular sizes after TAVR. In subjects receiving SAVR, the frequency ...
The Heart Surgery Forum, 2014
Background: Small aortic prosthesis can lead to prosthesis-patient mismatch (PPM). Implanting such small prosthesis remains a controversial issue. This study was done to investigate whether or not PPM causes an increased operative mortality in aortic valve replacement (AVR).Methods: Two-hundred-two consecutive patients undergoing primary AVR in a tertiary hospital were included. The sample was grouped according to the aortic valve prosthesis size: ?21 mm (small) and >21 mm (standard). The effect of variables on outcomes was determined by univariate and multivariable regression analyses.Results: PPM was found significantly more among patients with AVR ? 21mm (P < 0.0001). Moreover, the likelihood of mortality also was significantly higher in these patients (P < 0.0001). Univariate analysis demonstrated small prosthesis size, urgent operation, PPM, female gender, and NYHA Class IV as significant predictors of mortality. Multivariate regression identified female gender, PPM, a...
Global Journal of Health Science, 2014
We hypothesized that gender, age, aortic root dimension, blood group and Left Ventricular End Diastolic and Systolic Diameters may have a significant correlation with the size of mechanical valve used. Methods: We included 48 patients retrospectively who had been operated at a single tertiary hospital. All patients with aortic stenosis or regurgitation were included in the study. Patients who had undergone previous cardiac surgery or concomitant surgical procedures, such as coronary artery bypass grafting, were excluded from the study. Results: The median size of the valves used in males (23mm) and females (21mm) were significantly different (P = 0.001). Size of the valve used was significantly associated with Left Ventricular End Systolic Diameter (LVESD) (r = 0.327, P = 0.007) and aortic root dimension (r = 0.526, P < 0.001). Moreover, significantly higher values of LVESD were observed in the expired patients (P = 0.023). Conclusion: This study shows that aortic root dimension and gender may be important predictors for the size of the prosthetic aortic valve used in aortic valve replacement. Our study also concludes that LVESD has significant relationship with in-hospital mortality. However, more long term clinical trials should be conducted to confirm these relationships.
European heart journal cardiovascular Imaging, 2018
A 3D transoesophageal echocardiography (3D-TOE) reconstruction tool has recently been introduced. The system automatically configures a geometric model of the aortic root and performs quantitative analysis of these structures. We compared the measurements of the aortic annulus (AA) obtained by semi-automated 3D-TOE quantitative software and manual analysis vs. multislice computed tomography (MSCT) ones. One hundred and seventy-five patients (mean age 81.3 ± 6.3 years, 77 men) who underwent both MSCT and 3D-TOE for annulus assessment before transcatheter aortic valve implantation were analysed. Hypothetical prosthetic valve sizing was evaluated using the 3D manual, semi-automated measurements using manufacturer-recommended CT-based sizing algorithm as gold standard. Good correlation between 3D-TOE methods vs. MSCT measurements was found, but the semi-automated analysis demonstrated slightly better correlations for AA major diameter (r = 0.89), perimeter (r = 0.89), and area (r = 0.85...