A personalized aortic valve replacement using computed tomography-guided aortic valve neocuspidization. Analysis of mid-term results compared to standard Ozaki technique
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Abstract
Background
The original Ozaki technique involves sizing the neovalve cusps during cross-clamp. It leads to prolonging the ischemic time compared to standard surgical AVR. Measurements taken on the collapsed Aortic Root (AR) may also be inaccurate. We use preoperative Computed Tomography (CT) to perform more accurate sizing in physiological conditions and shorten the ischemic time. This study analyzes the results of the CT-guided Aortic Valve Neocuspidization (AVNeo) compared with the Ozaki technique.
Methods
The validity of the concept was evaluated ex vivo. Experimental valves underwent geometric, CT, and hydrodynamic controls. In the clinical phase of the study, we prospectively analyzed patients who received CT-guided AVNeo (N = 7, Group 1). The control group enrolled patients who were operated on after the standard AVNeo technique (N = 15, Group 2).
Results
In Group 1, Aortic Cross-Clamp (70.3 ± 17.0 vs. 91 ± 21.3 min, ρ = 0.026) and Bypass times (92.9 ± 21.0 vs. 123 ± 24.8 min, ρ = 0.011) were significantly shorter. At discharge, the peak (11.7 ± 2.75 vs. 15.4 ± 4.66 mm Hg, ρ = 0.032) and mean Aortic Valve (AV) gradient (6.29 ± 1.25 vs. 7.87 ± 2.33 mm Hg, ρ = 0.052) were lower in Group 1. Only one patient in Group 2 had Aortic Insufficiency (AI) greater than mild. The mean follow-up was 49.6 ± 6.9 months in both groups. There were no late deaths or any valve-related events detected in any patient. EchoCG revealed that peak (10.0 ± 2.65 vs. 12.6 ± 4.05 mm Hg, ρ = 0.090) and mean AV gradient (5.14 ± 1.35 vs. 6.73 ± 2.25 mm Hg, ρ = 0.054) also were lower in Group 1. AI indexes were stable in both Groups.
Conclusions
CT-guided AVNeo is an example of personalized medicine in the surgical treatment of heart valve pathology. It allows the development of a biological AV that adapts to the patient's anatomy, shortens ischemic time, and results in better hemodynamics.
A more significant number of clinical observations and longer follow-up are warranted to prove the viability of the concept.
期刊介绍：
The Journal of Cardiovascular Computed Tomography is a unique peer-review journal that integrates the entire international cardiovascular CT community including cardiologist and radiologists, from basic to clinical academic researchers, to private practitioners, engineers, allied professionals, industry, and trainees, all of whom are vital and interdependent members of our cardiovascular imaging community across the world. The goal of the journal is to advance the field of cardiovascular CT as the leading cardiovascular CT journal, attracting seminal work in the field with rapid and timely dissemination in electronic and print media.
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