Is small cusp size a limitation for aortic valve repair?†.
OBJECTIVES
We sought to investigate cusp size limitations for valve repair in patients with aortic regurgitation (AR).


METHODS
Preoperative computed tomography was performed in 105 patients. Cusp geometric height (GH) and annulus size were measured. Mean patient age was 60.7 ± 13.7 years. Mean GH of 3 cusps was used in the analysis. Annulus cusp mismatch was graded using predicted coaptation length. Patients were categorized by mean GH into group S (GH <16 mm; n = 35) or L (GH ≥16 mm; n = 70).


RESULTS
Preoperative mean GH was 17.1 ± 2.3 mm. GH and body height were significantly correlated (r = 0.61). Intraoperative mean GH (18.8 ± 2.2 mm) was larger than preoperative mean GH (P < 0.0001). However, postoperative (17.1 ± 2.0 mm) and preoperative mean GH did not differ. Moderate AR was not present on predischarge echocardiography. Mild AR was observed in 51% and 17% of patients in groups S and L, respectively (P = 0.006). During follow-up, moderate or severe AR was observed in 14% and 10% of patients in groups S and L, respectively (P = 0.74). Two patients in group S required reoperation for a regurgitant valve. Twenty (83%) and 15 (21%) patients in groups S and L, respectively, had severe annulus cusp mismatch before surgery. Annulus cusp mismatch resolved in most patients in group L postoperatively, whereas more than half the patients in group S still had severe mismatch.


CONCLUSIONS
Small cusp size (GH <16 mm) is not necessarily a contraindication in aortic valve repair. However, most patients in this group had annulus cusp mismatch. Root replacement or secure annulus plication is mandatory to correct annulus cusp mismatch.
['Komiya|Tatsuhiko|T|', 'Shimamoto|Takeshi|T|', 'Nonaka|Michihito|M|', 'Matsuo|Takehiko|T|']
D000368:Aged D001021:Aortic Valve D001022:Aortic Valve Insufficiency D000072226:Computed Tomography Angiography D004452:Echocardiography D005260:Female D006801:Humans D016896:Treatment Outcome
Computed tomography Geometric height Annulus cusp mismatch Coaptation length Aortic valve repair