Quantification of Aortic Cusp Parameters Using Computed Tomography in Valve-sparing Aortic Root Replacement Surgery: A Prospective Study

P0273 

Abstract Submission 

Hong Rae Kim (1), Joon Bum Kim (2)

(1) Asan Medical Center, Seoul, (2) Asan Medical Center, Seoul

Hong Rae Kim    -  Contact Me
Asan Medical Center

*Joon Bum Kim    -  Contact Me
Asan Medical Center

Hong Rae Kim    -  Contact Me
Asan Medical Center

Objectives
Determining the feasibility of valve-sparing aortic root replacement (VSRR) and achieving a successful repair requires a comprehensive understanding of the aortic root, which involves accurate preoperative measurements using currently available imaging modalities. Most relevant prior studies focused on parameters of the aorta, and only a few studies have evaluated the cusp parameters, which play a critical role in competent valve function. In this study, we examined whether the cusp profiles obtained from preoperative 3-D computed tomographic (CT) have acceptable degrees of agreement with actual intraoperative measurements.
Methods
In this prospective trial, we enrolled 32 consecutive patients (median 53.5 yrs, 29–79, 5 women) undergoing VSRR with a reimplantation technique from June 2021 to May 2022. The aortic cusp profiles, including the free-margin length and geometric height, were measured on preoperative cardiac CT. Comparisons between preoperative cardiac CT and intraoperative measurement of the aortic valve cusp were performed by Bland–Altman plots and the interclass-correlation method.
Results
Six patients had a bicuspid aortic valve, and 4 (12.5%) had Marfan syndrome. The degree of preoperative aortic insufficiency (AI) was non-to-trivial in 2 (6.3%), mild in 3 (9.4%), moderate in 5 (15.6%), and severe in 22 (68.8%). The mean differences in free-margin length between the two measurements were -3.29 mm (95% CI, -15.05–8.46 mm), -3.74 mm (95% CI, -16.47–8.98 mm), and -1.95 mm (95% CI, -11.96–8.06 mm) for the left, right, and non-coronary, respectively, with an acceptable strength of agreement (interclass correlation coefficient, 0.81, 0.80 and 1.87 for left-, right-, and non-coronary, respectively). The mean differences in geometric height were 0.31 mm (95% CI, -2.90–5.51 mm), 2.15 mm (95% CI, -3.73–8.02 mm,) and 1.93 mm (95% CI, -2.67–6.53 mm) for left, right, and non-coronary, respectively. There was a moderate strength of agreement (interclass correlation coefficient, 0.69, 0.44, and 0.60 for left-, right-, and non-coronary, respectively) for the cusp geometric height. During the VSRR, cusp plication was needed in 7 (21.9%) to correct the cusp asymmetry. Postoperative echocardiography showed none-to-mild AI in 31 (96.9%) patients, while 1 had mild-to-moderate AI.
Conclusions
The preoperative CT measurements of the aortic valve cusp showed reasonable predictive power for the free-margin length, albeit only limited accuracy for the geometric height measurement.

Aortic Root