Aortic Valve Replacement Sizes: What Should Patients Know?

Video Transcript:

Adam Pick: Hi, everybody. It's Adam with HeartValveSurgery.com, and we are at the American Association for Thoracic Surgery Conference in Chicago, Illinois. I'm thrilled to be joined by Dr. Christopher Mehta, who's the director of bicuspid aortic valve program and the aortic dissection program at the Bluhm Cardiovascular Institute at Northwestern Medicine in Chicago.

Dr. Mehta, it is great to see you again, and thanks for being with me today.

Dr. Christopher Mehta: Thanks for having me.

We’re here at AATS and we're getting lots of patient questions from our community. This one comes in from Jeanne, and she says, "I have a question about the fit and sizing of a replacement aortic valve. How does the surgeon or the team doing the procedure decide on the size of the replacement valve, and is it different for TAVR versus SAVR?"

Dr. Christopher Mehta: That's a great question. Everybody's aortic annulus, which is where the aortic valve lives is a different size. It's important that we get the right sized valve in. Generally speaking, we want to get as big a valve as we can, a tissue valve that is, to ensure long-term durability and also to ensure a setup for a future Valve-in-Valve transcatheter intervention if needed.

There's a lot of factors that go into determining what's the appropriate aortic valve size. Some of it we do pre-operatively, meaning we can look at a CT scan or an echocardiogram and see what the aortic annulus is, to get a sense of what size valve we're able to put in. The final determination is made at the time of surgery in, in surgical aortic valve replacement (SAVR) where we can actually use a physical sizer and determine what size valve is appropriate for that annulus.

Some people have an annulus which is maybe a little too small for their body habitus (type and size) and it might put them at risk of what's called a patient-prosthesis mismatch if we put too small a valve in that patient. So, we have techniques to actually make the aortic root, the aortic annulus bigger.

It's called an aortic root enlargement. and that allows us to actually make the annulus bigger so we can fit a bigger sized valve in. When we're talking in terms of transcatheter aortic valve replacement (TAVR), we do similar sizing, on a CT scan, and we're able to predict pretty good accuracy what's the appropriate valve.

Then, we use the commercially available devices based on, on the size of the annulus.

Now, when we're considering somebody for TAVR, it's a different story because obviously we don't have a technique to enlarge the aortic annulus like we do with surgery.

We use the CT scan to really carefully understand what is the biggest size valve that we can use. and we use either a balloon expandable or a self-expanding commercially available TAVR valve in that situation to fit the annulus. Sometimes the difference between TAVR and SAVR depends on whether we think somebody needs a larger valve than their annulus can accommodate.

And so that's one of many things that plays into a heart team decision when deciding TAVR versus SAVR.

Adam Pick: Wow. Well, Jeanne, I hope that helped you. I know it helped me learn more. And Dr. Mehta, on behalf of Jeanne, behalf of every patient in our community, people all over the world, thanks to you and your team at Northwestern Medicine for all the great work you're doing.

Thanks for being with me today.

Dr. Christopher Mehta: It's good to see you, Adam.