A Quantitative Approach For Preoperative Surgical Planning In Pediatric Aortic Valve Repair
Dominic Recco, MD, Nicholas Kneier, MS, Shannen Kizilski, PhD, Patrick Earley, BS, David Hoganson, MD, Christopher Baird, MD, Peter Hammer, PhD.
Boston Children's Hospital, Boston, MA, USA.
Objective(s): Repair-first strategy is preferred for congenital aortic valve (AoV) disease. Studies have identified reconstructed valve features (low coaptation [coapH] and effective [eH] height) as risk factors for early repair failure. We aimed to develop and validate a quantitative approach for preoperative planning in pediatric AoV repair to reliably restore normal valve proportions to facilitate long-term function.
Methods: Mathematical relationships for normal AoV proportions were derived relating sinotubular junction diameter(STJD), free edge length(feL), and commissure height(commH). Coaptation features(coapH, eH) were computed from these relationships, assuming parabolic leaflet free edge curvature. Ex-vivo validation was performed with valve-sparing root replacement on six porcine hearts with three tube graft sizes(STJD 19-25mm) with variation of commHs and feLs (smaller/equal to/greater than “ideal” for given STJD)(n=18).
Results: Our analytic model predicts valve competence and degree of coaptation (coapH, eH) based on reconstructed elements (STJD, feL, commH). The model can simulate multiple reconstruction scenarios in real-time using preoperative measurements. As predicted by the model, ex-vivo experiments with increasing commH (range 8.2-15.5mm) in all graft sizes with fixed native feL trended towards increasing eH and coapH; whereas, with a fixed commH, increasing feL (range 18.5-31.7mm) trended towards decreasing eH and coapH.
Conclusions: Utilizing a simulation-based approach, surgeons can manipulate valve dimensions to predict repaired valve features and determine patient-specific operative plans aiming to improve consistency of achieving optimal long-term dimensions and durability.
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