Comparison of Preoperative Aortic Valve Imaging Techniques for Patients with Aortic Insufficiency Undergoing Aortic Valve Repair Surgery
Presented During:
Thursday, April 25, 2024: 5:38PM - 7:00PM
Sheraton Times Square
Posted Room Name:
Central Park
Abstract No:
P0086
Submission Type:
Abstract Submission
Authors:
Kyle McCullough (1), Zuyue Wang (2), John Eisenga (1), Ghadi Moubarak (1), Tsung-Wei Ma (1), Amro Alsaid (2), J. Michael DiMaio (2), William Brinkman (2)
Institutions:
(1) Baylor Scott & White Research Institute, Plano, TX, (2) Baylor Scott & White Health - The Heart Hospital, Plano, TX
Submitting Author:
Kyle McCullough
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Baylor Scott & White Research Institute
Baylor Scott & White Research Institute
Co-Author(s):
Zuyue Wang
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Baylor Scott & White Health - The Heart Hospital
Baylor Scott & White Health - The Heart Hospital
John Eisenga
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Baylor Scott & White Research Institute
Baylor Scott & White Research Institute
Ghadi Moubarak
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Baylor Scott & White Research Institute
Baylor Scott & White Research Institute
Tsung-Wei Ma
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Baylor Scott & White Research Institute
Baylor Scott & White Research Institute
Amro Alsaid
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Baylor Scott & White Health - The Heart Hospital
Baylor Scott & White Health - The Heart Hospital
*J. Michael DiMaio
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Baylor Scott & White Health - The Heart Hospital
Baylor Scott & White Health - The Heart Hospital
*William Brinkman
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Baylor Scott & White Health - The Heart Hospital
Baylor Scott & White Health - The Heart Hospital
Presenting Author:
Kyle McCullough
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Abstract:
Objective: To report the comparative accuracy of dedicated preoperative 4D cardiac computed tomography angiogram (CTA), real-time 3D transesophageal echocardiography (TEE) and intraoperative techniques in aortic valve (AV) measurement and phenotype determination using the de Kerchove repair-oriented classification, in patients with trileaflet or bicuspid aortic valves undergoing surgery for predominant aortic insufficiency and/or root aneurysm.
Methods: This is a prospective, non-randomized, observational study of preoperative AV imaging for AV repair surgery. A total of 22 patients were accrued over a period of 12 months and followed for a minimum of 3 years postoperatively. Preoperative TEE and CTA were obtained and measurements provided by dedicated imaging cardiologists. Intraoperative measurements were obtained from the arrested heart and reported by the surgeon prior to repair. CTA was considered the comparative standard of AV phenotype and commissural orientation while intraoperative measurement was considered the standard for heights. Cohen's kappa (κ), Spearman's rank (rs) and Pearson (r) correlation coefficients were used to describe agreement of phenotype and measurements, as appropriate. Continuous variables are reported as a median with interquartile range or a mean with standard deviation if normally distributed.
Results: Assessment of AV phenotype and measurements of commissural orientation (CO), geometric height (gH) and functional commissural heights (fcH) are reported (Table 1). TEE (κ=0.902, p<0.01) was more likely to agree with CTA for AV phenotype than intraoperative assessment (κ=0.729, p<0.01), however both were likely to agree with CTA. TEE was thus more accurate than intraoperative measurement at predicting CO (rs=0.79, p<0.01 vs rs=0.58, p=0.01). Both CTA and TEE were unlikely to predict and measured shorter than intraoperative gH measurement. There was a low positive correlation of gH within CTA and TEE; neither tended to over or underestimate the other. Measurements of fcH by CTA did not agree with and were shorter than intraoperative measurement.
Conclusions: TEE appears more accurate than intraoperative assessment in predicting AV phenotype by measurement of CO compared to the gold standard of CTA. CTA and TEE did not agree with and predicted shorter gH and fcH than intraoperative measurement.
Methods: This is a prospective, non-randomized, observational study of preoperative AV imaging for AV repair surgery. A total of 22 patients were accrued over a period of 12 months and followed for a minimum of 3 years postoperatively. Preoperative TEE and CTA were obtained and measurements provided by dedicated imaging cardiologists. Intraoperative measurements were obtained from the arrested heart and reported by the surgeon prior to repair. CTA was considered the comparative standard of AV phenotype and commissural orientation while intraoperative measurement was considered the standard for heights. Cohen's kappa (κ), Spearman's rank (rs) and Pearson (r) correlation coefficients were used to describe agreement of phenotype and measurements, as appropriate. Continuous variables are reported as a median with interquartile range or a mean with standard deviation if normally distributed.
Results: Assessment of AV phenotype and measurements of commissural orientation (CO), geometric height (gH) and functional commissural heights (fcH) are reported (Table 1). TEE (κ=0.902, p<0.01) was more likely to agree with CTA for AV phenotype than intraoperative assessment (κ=0.729, p<0.01), however both were likely to agree with CTA. TEE was thus more accurate than intraoperative measurement at predicting CO (rs=0.79, p<0.01 vs rs=0.58, p=0.01). Both CTA and TEE were unlikely to predict and measured shorter than intraoperative gH measurement. There was a low positive correlation of gH within CTA and TEE; neither tended to over or underestimate the other. Measurements of fcH by CTA did not agree with and were shorter than intraoperative measurement.
Conclusions: TEE appears more accurate than intraoperative assessment in predicting AV phenotype by measurement of CO compared to the gold standard of CTA. CTA and TEE did not agree with and predicted shorter gH and fcH than intraoperative measurement.
Aortic Symposium:
Aortic Root
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