OBJECTIVES Complications like complete atrioventricular block (CAVB) and paravalvular leakage (PVL) following rapid deployment aortic valve (AV) replacement (RDAVR) remain unresolved. Selecting an optimal size of the valve might be important to minimize the incidence of these complications. We sought to determine the impact of prosthesis size relative to the anatomic profile of the AV on the occurrence of CAVB or PVL after RDAVR. METHODS Preoperative computed tomographic (CT) images were evaluated in patients receiving RDAVR (INTUITY ELITE) between February 2016 and December 2019. The occurrence of CAVB requiring permanent pacemaker implantation and PVL (≥ mild) was evaluated. The relative size of implants against the cross-sectional dimensions of recipients’ AV annulus and left ventricular outflow tract (LVOT) were calculated. RESULTS Among 187 eligible patients, CAVB and PVL (≥ mild) occurred in 12 (6.4%) and 11 patients (5.9%), respectively. CAVB was associated with oversized RDAVR (RDAVR frame width minus average diameter of LVOT calculated from the cross-sectional area [ΔLVOTarea]: odds ratio, 2.05; 95% confidence interval, 1.28–3.30): this was with an area under the curve of 0.78 (P = 0.005). The projected probability of CAVB was <3% when the ΔLVOTarea was <1.3. In contrast, PVL was associated with under-sized RDAVR (RDAVR size divided by the longest diameter of AV annulus [index Annlong]: odds ratio, 0.64; 95% confidence interval, 0.51–0.79): This was with an area under curve of 0.94 (P < 0.001). CONCLUSIONS CT parameters of the AV annulus and LVOT are highly reliable in the prediction of CAVB or PVL after RDAVR. Our data might justify CT-based sizing of prosthesis for RDAVR.

中文翻译：

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三维计算机断层扫描评估预测快速部署主动脉瓣置换术后的传导阻滞和瓣周漏

目标 快速部署主动脉瓣 (AV) 置换 (RDAVR) 后的完全性房室传导阻滞 (CAVB) 和瓣周漏 (PVL) 等并发症仍未得到解决。选择瓣膜的最佳尺寸对于最大限度地减少这些并发症的发生率可能很重要。我们试图确定假体尺寸相对于 AV 解剖结构对 RDAVR 后 CAVB 或 PVL 发生的影响。方法 对 2016 年 2 月至 2019 年 12 月期间接受 RDAVR (INTUITY ELITE) 的患者的术前计算机断层扫描 (CT) 图像进行评估。评估需要永久性起搏器植入的 CAVB 和 PVL（≥轻度）的发生率。计算了植入物相对于受者 AV 环和左心室流出道 (LVOT) 横截面尺寸的相对尺寸。结果 在 187 名符合条件的患者中，CAVB 和 PVL（≥轻度）分别发生在 12 名（6.4%）和 11 名患者（5.9%）中。CAVB 与超大 RDAVR 相关（RDAVR 框架宽度减去根据横截面积计算的 LVOT 平均直径 [ΔLVOTarea]：优势比，2.05；95% 置信区间，1.28-3.30）：曲线下面积为0.78 (P = 0.005)。当 ΔLVOTarea ＜1.3 时，CAVB 的预计概率为＜3%。相比之下，PVL 与 RDAVR 尺寸过小相关（RDAVR 尺寸除以 AV 环最长直径 [指数 Annlong]：优势比，0.64；95% 置信区间，0.51-0.79）：曲线下面积为0.94 (P＜0.001)。结论 AV 环和 LVOT 的 CT 参数在预测 RDAVR 后的 CAVB 或 PVL 方面具有很高的可靠性。