P086. Comparison of Preoperative Aortic Valve Imaging Techniques for Patients with Aortic Insufficiency Undergoing Aortic Valve Repair Surgery
Presented During: POD Abstracts (Available for viewing in the exhibit hall for the duration of the meeting)
Baylor Scott & White Research Institute
Dallas, TX
United States - Contact Me
Dr. McCullough is a research fellow in cardiothoracic surgery under the mentorship of Dr. J. Michael DiMaio at the Baylor Scott & White Research Institute in Plano, Texas. Following undergraduate education at Southern Illinois University Edwardsville and medical school at Southern Illinois University, he completed his general surgery training at the University of California San Francisco - Fresno. He has also completed a fellowship in surgical critical care with an emphasis in extracorporeal life support and cardiovascular intensive care unit management at Baylor University Medical Center in Dallas, Texas. He plans to enter cardiothoracic surgery training following his research fellowship.
Thursday, April 25, 2024: 5:38 PM - 7:00 PM
Sheraton Times Square
Room: Central Park
Description
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.
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
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.
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
Presentation Duration
PODS will be on display in the exhibit hall for the duration of the meeting during exhibit hall hours. PODS will also be available for viewing on the meeting website. There is no formal presentation associated with your POD, but we encourage you to visit the PODS area during breaks to connect with those viewing.