Transthoracic echocardiography for selection of tubular graft size in David reimplantation technique.

Abstract

OBJECTIVES:

Selection of tubular graft size during David reimplantation technique for aortic root dilatation is based on perioperative leaflet height measurements. The present study evaluated whether transthoracic echocardiography (TTE)-based algorithms may help in selecting the graft size preoperatively.

METHODS:

Thirty patients (52 ± 11 years old, 73% men) who underwent David reimplantation technique were evaluated. The implanted graft size was based on the David's formula. Leaflet height [diameter = 1.1 × ((2 × 2/3 × leaflet height) + 2)), leaflet length (diameter = ((2 × 2/3 × leaflet length) + 2)] and leaflet area [diameter = 0.8 × ((2 × √(total leaflet area/π)) + 2)] TTE-derived formulas were retrospectively developed. The percentage of under- or oversized implanted grafts was calculated and the association between the adequacy of graft sizing using TTE-derived formulas and the incidence of residual aortic regurgitation (AR) was evaluated retrospectively.

RESULTS:

The incidence of postoperative mild residual AR was 23%. The true diameter of the inplanted graft was oversized based on leaflet height in 15 (50%) patients, based on leaflet length in 13 (43%) patients and based on leaflet area TTE-derived formula in 11 (37%) patients. The incidence of mild AR was significantly lower in undersized grafts compared with oversized grafts based on leaflet length TTE-derived formula (6 vs 46%, P = 0.032) and leaflet area TTE-derived formula (5 vs 55%, P = 0.009).

CONCLUSIONS:

In patients undergoing David reimplantation technique, grafts considered undersized according to the leaflet length or leaflet area TTE-derived formula were associated with less incidence of residual AR than patients with oversized grafts.

• Authors: Madelien V Regeer, Michel I M Versteegh, Robert J M Klautz, Martin J Schalij, Jeroen J Bax, Nina Ajmone Marsan, Victoria Delgado
• Journal: Interactive cardiovascular and thoracic surgery (Interact Cardiovasc Thorac Surg) Vol. 21 Issue 4 Pg. 459-64 (Oct 2015) ISSN: 1569-9285 [Electronic] England
• PMID: 26160964 (Publication Type: Journal Article)
• Copyright: © The Author 2015. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

Topics

• Adult
• Aorta (diagnostic imaging, pathology, surgery)
• Aortic Diseases (diagnostic imaging, pathology, surgery)
• Aortic Valve Insufficiency (etiology, surgery)
• Blood Vessel Prosthesis
• Blood Vessel Prosthesis Implantation (methods)
• Dilatation, Pathologic (complications, surgery)
• Echocardiography
• Female
• Humans
• Male
• Middle Aged
• Retrospective Studies