Division of Cardiovascular Surgery, Department of Surgery, Lewis Katz School of Medicine-Temple University, Philadelphia, PA.
Division of Cardiovascular Surgery, Department of Surgery, Lewis Katz School of Medicine-Temple University, Philadelphia, PA.
Surgery. 2020 Feb;167(2):499-503. doi: 10.1016/j.surg.2019.06.022. Epub 2019 Aug 8.
Multidetector computed tomography is vital in preoperative sizing for transcatheter aortic valve replacement. The purpose of this study is to determine whether preoperative transcatheter aortic valve replacement multidetector computed tomography accurately predicts surgical aortic valve prosthesis size.
Between July 2012 and July 2017, 102 patients who underwent surgical aortic valve replacement had preoperative aortic valve sizing by multidetector computed tomography. The aortic annulus diameter calculated using multidetector computed tomography was compared with intraoperative valve sizing during surgical aortic valve replacement.
Forty-one (40.2%) of the 102 patients studied had multidetector computed tomography aortic valve measurements that were accurate. Implanted valves were smaller than multidetector computed tomography calculation in 40 patients (39.2%) and were larger in 21 patients (20.6%). Multidetector computed tomography measurements remained inconsistent with intraoperative sizing regardless of aortic annulus diameter. The variance between multidetector computed tomography annulus measurements and intraoperative sizing was statistically significant.
Preoperative aortic annulus measurements by our institutional transcatheter aortic valve replacement multidetector computed tomography protocol differed substantially from surgical implant size. There was no trend toward over nor under sizing for the entire cohort. However, patients with large measured annulus diameter were more likely to have a smaller valve implanted than predicted, and patients with small measured annulus diameter were more likely to have a larger valve implanted than predicted. These results may affect preoperative planning for patients undergoing aortic valve replacement.
多排螺旋 CT 在经导管主动脉瓣置换术的术前 sizing 中至关重要。本研究旨在确定术前经导管主动脉瓣置换术多排螺旋 CT 是否能准确预测外科主动脉瓣假体尺寸。
在 2012 年 7 月至 2017 年 7 月期间，102 例行外科主动脉瓣置换术的患者接受了术前主动脉瓣 sizing 多排螺旋 CT。多排螺旋 CT 计算的主动脉瓣环直径与外科主动脉瓣置换术中的术中瓣膜 sizing 进行了比较。
在研究的 102 例患者中，有 41 例（40.2%）的多排螺旋 CT 主动脉瓣测量值是准确的。在 40 例患者（39.2%）中植入的瓣膜比多排螺旋 CT 计算的小，在 21 例患者（20.6%）中植入的瓣膜比多排螺旋 CT 计算的大。无论主动脉瓣环直径如何，多排螺旋 CT 测量值与术中 sizing 均不一致。多排螺旋 CT 瓣环测量值与术中 sizing 之间的差异具有统计学意义。
我们机构的经导管主动脉瓣置换术多排螺旋 CT 方案术前主动脉瓣环测量值与外科植入尺寸有很大差异。整个队列没有过度或不足的趋势。然而，测量瓣环直径较大的患者植入的瓣膜比预测的小，而测量瓣环直径较小的患者植入的瓣膜比预测的大。这些结果可能会影响接受主动脉瓣置换术的患者的术前计划。
