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Cardiac Computed Tomography-Guided Sizing of Sutureless Aortic Valves
Kavya Sinha, Moritz C. Wyler von Ballmoos, Pimprapa Vejpongsa, John Mahmarian, Michael J. Reardon, Mahesh K. Ramchandani.
Houston Methodist Hospital, Houston, TX, USA.

OBJECTIVE: 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. We studied 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: 45 consecutive patients were studied using gated cardiac CT-angiography (CCTA) prior to SAVR. Demographic, anthropometric and CCTA measurements were recorded prior to surgery and patients underwent valve replacement using the Perceval sizers and bioprosthesis (S: n=11; M: n=15; L: n=12; XL: n=7).
RESULTS: 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 similar measurements but the majority received the larger prosthesis (15/26), demonstrating the impact of leaflet resection and decalcification of the aortic annulus.
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 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 will be valuable when choosing between SAVR versus TAVR.

CCTA measurements
Implanted ValvePerimeter (mm)Max Diameter (mm)Min Diameter (mm)
Small (19-21mm)71.7 (61-81)24.8(22-27)19.3(16-21)
Medium (23-25mm)74.2 (52-84)25.7 (17-31)19.9 (15-22)
Large (25-27mm)79.5 (24-93)34.2 (24-83)22.5 (19-25)
XLarge (27-29mm)96.1 (84-111)34(28-40)26.1(24-29)

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