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Annulus Size, Valve Labels, And Geometric Orifice Area: A Therapeutic Conundrum
B. A. YOUDELMAN, H. JAIN, H. HIROSE, J. W. ENTWISTLE, A. S. WECHSLER*. DREXEL UNIVERSITY COLLEGE OF MEDICINE, Philadelphia, PA,
Background: Is there a predictable relationship between the geometric orifice area (GOA) of valves sized to fit into a specific annulus? This is a concern in patients at risk for patient prosthesis mismatch. Valve sizers from multiple manufacturers can not be safely compared in a clinical setting because of time and potential injury to cardiovascular structures. We studied 50 cadavers to determine the relationship between the true measured annular diameter and the GOA of the aortic valve chosen based on its sizer. Methods: Aortic annular diameters were determined in 50 fresh cadaver hearts. Valve sizers for 3 bioprosthetic and 5 mechanical valves determined the largest valve that could be fit into each annulus. Results: Labeled valve size did not correlate statistically to measured annular diameter. When appropriately sized, tissue valves had a statistically larger GOA than mechanical valves. Relationship between GOA and annular size was investigated through regression analysis and important inter-valve differences were observed between y-intercepts and slopes (Fig 1). Conclusions: Surgeons believe that valve sizers correlate closely with GOA and annular size. Our study showed important statistical differences in GOA amongst aortic valves appropriately sized for any true measured annular diameter. Using GOA allowed comparison between valves with a reproducible measure. Labeled valve size is misleading and cannot be used alone to optimize valve selection. This further reinforces the need for standardization. 
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