Work

Computed tomography−based prediction of commissural positions facilitates valve-sparing aortic root replacement

Year: 2025

Type: article

Abstract: Objectives: This study aimed to compare aortic root reimplantation planning using computed tomography (CT) with conventional methods and to assess the accuracy of automated CT measurements using a deep-learning algorithm. Methods: Twenty patients underwent David reimplantation at our hospital with CT-based planning to determine graft sizes from virtual basal ring dimensions and predict commissural positions using electrocardiogram-gated CT. In the controls (n = 20), preoperative transesophageal echocardiography determined virtual basal ring sizing, whereas surgeons intraoperatively assessed commissural positions. We also analyzed correlations between CT measurements obtained manually by experts and automatically by our deep-learning-based algorithm using 50 cases indicated for David reimplantation. Results: = .018). Algorithm-based measurements showed excellent agreement with expert measurements for virtual basal ring diameters, intercommissural distances, and commissural heights (differences: -0.3 to 0.1 mm; intraclass correlation coefficients: 0.87-0.97). Conclusions: For David reimplantation, CT-based planning of graft sizes and commissural positions may reduce the need for intraoperative commissural position adjustments and cusp repair. Our deep learning-based algorithm can replace expert measurements in standardized surgical planning.

Source: JTCVS Techniques

DOI: 10.1016/j.xjtc.2025.11.007