Department of Cardiovascular Surgery, University Medical Center, University of Medicine and Pharmacy at Ho Chi Minh City, 215 Hong Bang Street, District 5, Ho Chi Minh City, Vietnam.
Department of Cardiovascular Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan.
J Cardiothorac Surg. 2021 Aug 4;16(1):221. doi: 10.1186/s13019-021-01601-z.
Patient-prosthesis mismatch (PPM) is a major concern in aortic valve replacement (AVR) and leads to perioperative morbidity and rehospitalization. Predicting aortic annulus diameter pre-procedurally is crucial to managing patients with high-risk of PPM.
To compare preoperative measurements of aortic annulus from echocardiography and CT scan with surgical sizing and develop an imaging-based algorithm to predict PPM.
From January 2017 to December 2020, patients underwent AVR at a teaching hospital were examined. The relationship between imaging measurements with operative values was assesed using scatter plots and Pearson's correlation coefficient. Univariable linear regression was then used to build the predictive model.
A total of 144 patients underwent AVR during the study period. Suture types and surgical approaches were not significantly associated with prosthesis size. CT scan-based measurements showed strong correlation with prosthesis size: mean diameter (R = 0.79), perimeter-derived diameter (R = 0.76), and area-derived diameter (R = 0.75). Mechanical valve and tissue valve shared similar correlation coefficients. Prosthesis size predictive models based on CT scan were 12.89 + 0.335 × d for mean diameter, 13.275 + 0.315 × d for perimeter-derived diameter and 13.626 + 0.309 × d for area-derived diameter.
Preoperative CT scan measurements are a reliable predictor of aortic prosthesis size. Transthoracic echocardiography is a possible alternative, though it is highly performer-dependent and unable to represent the aortic annulus fully. Together, these two imaging modalities can be used to quantitatively anticipate PPM preoperatively.
人工瓣膜-患者不匹配（PPM）是主动脉瓣置换（AVR）的主要关注点，会导致围手术期发病率和再住院率升高。术前预测主动脉瓣环直径对于管理 PPM 高危患者至关重要。
比较经胸超声心动图和 CT 扫描测量的主动脉瓣环与手术测量值，并建立一种基于影像学的预测 PPM 的算法。
本研究纳入了 2017 年 1 月至 2020 年 12 月在一家教学医院接受 AVR 的患者。使用散点图和 Pearson 相关系数评估影像学测量值与手术值之间的关系。然后使用单变量线性回归建立预测模型。
研究期间共有 144 例患者接受了 AVR。瓣膜类型和手术入路与瓣膜尺寸无显著相关性。CT 扫描测量值与瓣膜尺寸具有很强的相关性：平均直径（R=0.79）、周长衍生直径（R=0.76）和面积衍生直径（R=0.75）。机械瓣和生物瓣具有相似的相关系数。基于 CT 扫描的瓣膜尺寸预测模型为平均直径为 12.89+0.335×d、周长衍生直径为 13.275+0.315×d、面积衍生直径为 13.626+0.309×d。
术前 CT 扫描测量值是主动脉瓣假体尺寸的可靠预测指标。经胸超声心动图可能是一种替代方法，但它高度依赖于操作者，且无法充分代表主动脉瓣环。这两种影像学方法可以结合使用，术前定量预测 PPM。
