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Predicting the ideal Valve Size during Aortic Valve Replacement with Rapid Deployment Bioprosthetic Valves. Is Intraoperative Transesophageal Echocardiography reliable?
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  • Ali Al-Alameri,
  • Alejandro Macias,
  • Evan Markell,
  • Julio Benitez,
  • Alvaro Montoya,
  • Michael Magarakis
Ali Al-Alameri
Jackson Memorial Hospital
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Alejandro Macias
University of Miami Health System
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Evan Markell
Miami VA Medical Center - University of Miami Miller School of Medicine
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Julio Benitez
Miami VA Medical Center - University of Miami Miller School of Medicine
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Alvaro Montoya
Miami VA Medical Center - University of Miami Miller School of Medicine
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Michael Magarakis
Miami VA Medical Center - University of Miami Miller School of Medicine
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Peer review status:UNDER REVIEW

14 May 2020Submitted to Journal of Cardiac Surgery
15 May 2020Assigned to Editor
15 May 2020Submission Checks Completed
20 May 2020Reviewer(s) Assigned

Abstract

Sutureless/rapid deployment valves provide surgeons with a new tool for aortic valve replacement (AVR) therapy, which can simplify the procedure. A main concern being the development of a paravalvular leak. We retrospectively reviewed our Aortic Valve Replacement database, were able to identify 25 rapid deployment aortic valves (INTUITY Valve System, Edwards Life Sciences LLC, Irvine, Calif) that had documented intraoperative Transesophageal Echocardiographic Annular measurements. All valves were implanted in the Aortic position. In this cohort, only patients that had their native aortic valve replaced either isolated or as part of any additional procedure were included. Patients that underwent Intuity valve implantation for Redo Aortic valve replacement were excluded from this study. After review of 25 patients who underwent rapid deployment valve implantation in the aortic position, 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 on intraoperative TEE was 22.4 mm (range: 21-28 mm). The mean valve size that we implanted was 23.3 mm (range: 21-27 mm). No statistically significant difference between the mean annular measurement and the valve size selected (0.9 mm , p = 0.8) were found. TEE is perhaps remains as one of our most important tool to further enhance valve sizing and appropriately guide one through a proper and safe deployment.