Assessing the Ideal Valve Size During Aortic Valve Replacement with
Rapid Deployment Bioprosthetic Valves. Is Intraoperative Transesophageal
Echocardiogram Reliable?
Abstract
Objective: To describe our experience with using intraoperative
Transesophageal Echocardiography (TEE) to assess the size of the rapid
deployment prosthetic valves by measuring the native aortic annulus.
Methods: Retrospective review of single institution series of patients
undergoing Aortic Valve Replacement with Rapid Deployment Bioprosthetic
Valves. Included were patients who had their native aortic valve
replaced either isolated or as part of any additional procedure. The
aortic annulus was measured prior to initiation of the operation using
TEE. An analysis was conducted between Echocardiographic annular
measurements and actual implanted valve sizes. Results: Forty patients
underwent rapid deployment valve implantation in the aortic position. Of
these, 32.5% of patients had the same size valve as the measured aortic
annulus, 40% of patients had a valve implanted that was 1 mm different,
and 25% of patients had 2 mm difference. One patient (2.5%) was found
to have an aortic annular measurement of 3mm less than the actual
implanted valve. The mean annular size based on intraoperative TEE was
23.5 mm (range: 21-28 mm, sdv: 1.8). The mean valve size implanted was
23.7 mm (range: 21-27 mm, sdv: 1.9). There was no statistically
significant difference between the mean annular measurement and the
valve size selected (0.2 mm, p = 0.50). 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.