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Predicting the Ideal Valve Size During Aortic Valve Replacement with Rapid Deployement Bioprosthetic Valves. Is Intraoperative Transesophageal Echocardiogram Reliable?
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  • Ali Al-Alameri,
  • Alejandro Macias,
  • Daniel Buitrago,
  • Alvaro Montoya,
  • Evan Markell,
  • Julio Benitez,
  • Michael Magarakis
Ali Al-Alameri
Jackson Memorial Hospital
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Alejandro Macias
University of Miami Health System
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Daniel Buitrago
University of Miami Miller School of Medicine; Jackson Memorial Hospital; Department of Surgery, Division of Cardiothoracic Surgery
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Alvaro Montoya
Miami VA Medical Center - University of Miami Miller School of Medicine
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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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Michael Magarakis
Miami VA Medical Center - University of Miami Miller School of Medicine
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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.

Peer review status:IN REVISION

13 Nov 2020Submitted to Journal of Cardiac Surgery
19 Jul 2021Assigned to Editor
19 Jul 2021Submission Checks Completed
19 Jul 2021Reviewer(s) Assigned
05 Aug 2021Review(s) Completed, Editorial Evaluation Pending
09 Aug 2021Editorial Decision: Revise Major