Predicting the Ideal Valve Size During Aortic Valve Replacement with
Rapid Deployement Bioprosthetic Valves. Is Intraoperative
Transesophageal Echocardiogram Reliable?
Abstract
Objective: To describe experience with using intraoperative
Transesophageal Echocardiography to reliably predict the size of the
rapid deployment prosthetic valve by measuring the native aortic annulus
Methods: Retrospective review of single institution series of patients
undergoing Aortic Valve Replacement with Rapid Deployement Bioprosthetic
Valves. Included were patients that had their native aortic valve
replaced either isolated or as part of any additional procedure. Aortic
annulus was measured prior to initiation of the operation using
transesophageal echocardiography (TEE). Correlation analysis was
conducted between Echocardiographic annular measurements and actual
implanted valve sizes. Results: Twenty five patients underwent rapid
deployment valve implantation in the aortic position. Of these, 36% of
patients had the same size valve as the measured aortic annulus, 48% of
patients had a valve implanted that was 1 mm different, and 16% of
patients had 2 mm difference. The mean annular size based was 22.4 mm
(range: 21-28 mm). The mean valve size implanted was 23.3 mm (range:
21-27 mm). There was no statistically significant difference between the
mean annular measurement and the valve size selected (0.9 mm , p = 0.8).
Conclusion: TEE can further enhance valve sizing and guidance through a
proper and safe deployment. Although evident in our experience, larger
scale studies are needed to further elucidate conclusions on the
importance of avoiding under-sizing valves.