Assessment of consistency in aortic valve sizing between surgical and transcatheter aortic valve replacement

Jan Jastrzebski; Maciej Dąbrowski; Krzysztof Kuśmierski; Cezary Kępka; Aleksandra Mioduszewska; Zbigniew Chmielak; Adam Witkowski; Jacek Kądziela

doi:10.5114/aic.2023.125154

Assessment of consistency in aortic valve sizing between surgical and transcatheter aortic valve replacement

Postepy Kardiol Interwencyjnej. 2023 Mar;19(1):40-46. doi: 10.5114/aic.2023.125154. Epub 2023 Feb 16.

Authors

Jan Jastrzebski¹, Maciej Dąbrowski¹, Krzysztof Kuśmierski², Cezary Kępka³, Aleksandra Mioduszewska¹, Zbigniew Chmielak¹, Adam Witkowski¹, Jacek Kądziela¹

Affiliations

¹ Department of Interventional Cardiology and Angiology, National Institute of Cardiology, Warsaw, Poland.
² Department of Cardiac Surgery and Transplantology, National Institute of Cardiology, Warsaw, Poland.
³ Department of Coronary Artery and Structural Heart Diseases, National Institute of Cardiology, Warsaw, Poland.

Abstract

Introduction: One of the crucial aspects of transcatheter aortic valve replacement (TAVR) and surgical aortic valve replacement (SAVR) is the valve prosthesis selection.

Aim: To assess the consistency of the aortic valve sizing in SAVR and TAVR by comparing the sizes of aortic prostheses selected based on the intraprocedural annulus measurements and simulation of the TAVR planning.

Material and methods: The study comprised of 167 patients with aortic stenosis treated with SAVR. Simulation of the prosthesis sizing blinded to the SAVR results was performed based on the assessment of cardiac computed tomography (CCT) images.

Results: Based on the CCT images, the average value of the aortic annulus diameter was 25.4 ±3.0 mm. Aortic valve calcifications were mild in 29 cases, moderate in 78 cases, and severe in 53 cases. The sizes of the valves recommended by the simulations were larger than valves surgically implanted in 98.6% of patients for self-expanding and in 91.7% of patients for balloon-expandable prostheses. The average difference for self-expanding prostheses was 6.4 mm and 4.5 mm for balloon expandable valves. Additionally, a negative correlation was observed for the difference in prosthesis size and size of the valve used by surgeons.

Conclusions: There is a systematic difference between sizes of aortic prostheses used in SAVR and TAVR. Further studies are needed to evaluate if the difference in prosthesis size selection contributes to the frequency of prosthesis-patient mismatch phenomenon and burden of high postoperative mean transaortic gradient.

Keywords: aortic stenosis; computed tomography; patient prosthesis mismatch.