title: Transthoracic echocardiography for selection of tubular graft size in David reimplantation technique.
abstract: OBJECTIVE
  Selection of tubular graft size during David reimplantation technique for aortic root dilatation is based on perioperative leaflet height measurements. The present study evaluated whether transthoracic echocardiography (TTE)-based algorithms may help in selecting the graft size preoperatively.
  
  
  METHODS
  Thirty patients (52 ± 11 years old, 73% men) who underwent David reimplantation technique were evaluated. The implanted graft size was based on the David's formula. Leaflet height [diameter = 1.1 × ((2 × 2/3 × leaflet height) + 2)), leaflet length (diameter = ((2 × 2/3 × leaflet length) + 2)] and leaflet area [diameter = 0.8 × ((2 × √(total leaflet area/π)) + 2)] TTE-derived formulas were retrospectively developed. The percentage of under- or oversized implanted grafts was calculated and the association between the adequacy of graft sizing using TTE-derived formulas and the incidence of residual aortic regurgitation (AR) was evaluated retrospectively.
  
  
  RESULTS
  The incidence of postoperative mild residual AR was 23%. The true diameter of the inplanted graft was oversized based on leaflet height in 15 (50%) patients, based on leaflet length in 13 (43%) patients and based on leaflet area TTE-derived formula in 11 (37%) patients. The incidence of mild AR was significantly lower in undersized grafts compared with oversized grafts based on leaflet length TTE-derived formula (6 vs 46%, P = 0.032) and leaflet area TTE-derived formula (5 vs 55%, P = 0.009).
  
  
  CONCLUSIONS
  In patients undergoing David reimplantation technique, grafts considered undersized according to the leaflet length or leaflet area TTE-derived formula were associated with less incidence of residual AR than patients with oversized grafts.
authors.affiliation: Heart Lung Center, Leiden University Medical Center, Leiden, Netherlands.
authors.forename: Madelien V
authors.initials: MV
authors.lastname: Regeer
authors.affiliation: Heart Lung Center, Leiden University Medical Center, Leiden, Netherlands.
authors.forename: Michel I M
authors.initials: MI
authors.lastname: Versteegh
authors.affiliation: Heart Lung Center, Leiden University Medical Center, Leiden, Netherlands.
authors.forename: Robert J M
authors.initials: RJ
authors.lastname: Klautz
authors.affiliation: Heart Lung Center, Leiden University Medical Center, Leiden, Netherlands.
authors.forename: Martin J
authors.initials: MJ
authors.lastname: Schalij
authors.affiliation: Heart Lung Center, Leiden University Medical Center, Leiden, Netherlands.
authors.forename: Jeroen J
authors.initials: JJ
authors.lastname: Bax
authors.affiliation: Heart Lung Center, Leiden University Medical Center, Leiden, Netherlands.
authors.forename: Nina
authors.initials: N
authors.lastname: Ajmone Marsan
authors.affiliation: Heart Lung Center, Leiden University Medical Center, Leiden, Netherlands v.delgado@lumc.nl.
authors.forename: Victoria
authors.initials: V
authors.lastname: Delgado
mesh_terms: D000328:Adult; D001011:Aorta / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D001018:Aortic Diseases / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery*; D001022:Aortic Valve Insufficiency / Q000209:etiology / Q000601:surgery*; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000379:methods*; D004108:Dilatation, Pathologic / Q000150:complications / Q000601:surgery; D004452:Echocardiography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies
keywords: Aortic root; Echocardiography; Surgery