Kimura Satoshi, Ushijima Tomoki, Fujita Satoshi, Sonoda Hiromichi, Oishi Yasuhisa, Tanoue Yoshihisa, Shiose Akira
Department of Cardiovascular Surgery, Kyushu University Hospital, 3-1-1, Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan.
Gen Thorac Cardiovasc Surg. 2021 Mar;69(3):466-471. doi: 10.1007/s11748-020-01469-1. Epub 2020 Aug 31.
Electrocardiographic (ECG)-gated computed tomography (CT) can be used to determine which valve and size should be used in transcatheter aortic valve replacement (TAVR). It is beneficial to predict the accurate annulus diameter in surgical aortic valve replacement (SAVR), which can help in determining the surgical strategy. We aimed to compare the predicted aortic annulus size with the actual annulus size measured intraoperatively and to examine its validity.
A total of 88 patients underwent isolated or concomitant SAVR in 2018 at our hospital. The study population consisted of 45 patients who underwent preoperative CT assessment and intraoperative measurement. The perimeter- and area-derived diameters at the level of basal attachments were determined using CT, and the lower value among the two was defined as the predicted aortic annulus (CTpredict). The predicted aortic annulus (TTEpredict) was measured by transthoracic echography in the parasternal long-axis view. An actual-sized ball sizer was inserted into the annulus intraoperatively. True annulus size was determined as the labeled size that just fits on the annulus, and labeled size plus 1 mm was determined as one that passes through the annulus.
There was better agreement with minimal bias between CTpredict and true annulus size as demonstrated in the Bland-Altman analysis with an intraclass correlation coefficient of 0.796 compared with TTEpredict.
ECG-gated CT is also helpful in predicting the annulus diameter even in patients undergoing SAVR. This has important clinical implications for planning SAVR, including the surgical approach.
心电图（ECG）门控计算机断层扫描（CT）可用于确定经导管主动脉瓣置换术（TAVR）中应使用的瓣膜及尺寸。在外科主动脉瓣置换术（SAVR）中预测准确的瓣环直径有益，这有助于确定手术策略。我们旨在比较预测的主动脉瓣环尺寸与术中测量的实际瓣环尺寸，并检验其有效性。
2018年我院共有88例患者接受了单纯或联合SAVR。研究人群包括45例接受术前CT评估和术中测量的患者。使用CT确定基底附着水平处基于周长和面积得出的直径，两者中的较低值定义为预测的主动脉瓣环（CTpredict）。通过经胸超声心动图在胸骨旁长轴视图中测量预测的主动脉瓣环（TTEpredict）。术中将实际尺寸的球囊扩张器插入瓣环。真实瓣环尺寸确定为刚好适合瓣环的标记尺寸，标记尺寸加1毫米确定为能通过瓣环的尺寸。
Bland-Altman分析显示，与TTEpredict相比，CTpredict与真实瓣环尺寸之间的一致性更好，偏差最小，组内相关系数为0.796。
即使对于接受SAVR的患者，ECG门控CT在预测瓣环直径方面也有帮助。这对规划SAVR具有重要的临床意义，包括手术入路。
