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Peer-reviewedCC BY-NC 4.0Yonsei Medical Journal

Quantification of Aortic Cusp Parameters Using Computed Tomography in Valve-Sparing Aortic Root Replacement Surgery: A Prospective Study

  • Hong Rae Kim1
  • Dong Hyun Yang2
  • Joon Bum Kim1
  1. 1Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea .
  2. 2Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea .
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Abstract

Purpose: Determining the feasibility of valve-sparing aortic root replacement (VSRR) requires accurate preoperative assessment of aortic valve cusp geometry. However, the reliability of computed tomography (CT) for measuring cusp parameters remains unclear. This study evaluated the agreement between CT-derived cusp measurements and intraoperative measurements and explored the potential of CT-based cusp asymmetry to predict intraoperative cusp plication.

Materials and Methods: In this prospective study, 32 consecutive patients undergoing VSRR with the reimplantation technique were enrolled. Preoperative CT was used to measure cusp free margin length and geometric height. Agreement between CT-derived and intraoperative measurements was assessed using Bland–Altman analysis and intraclass correlation coefficients (ICCs). An exploratory analysis evaluated whether CT-derived cusp asymmetry predicted the need for intraoperative cusp plication.

Results: CT measurements demonstrated good agreement with intraoperative measurements for cusp free margin length (ICC 0.80–0.87). In contrast, geometric height showed only moderate agreement (ICC 0.44–0.69). Exploratory receiver operating characteristic analysis demonstrated moderate discriminative ability of CT-derived cusp asymmetry for predicting intraoperative cusp plication (area under the curve, 0.71; 95% confidence interval, 0.49–0.91), although the association did not reach statistical significance (p=0.06). Postoperative echocardiography demonstrated none-to-mild aortic insufficiency in 96.9% of patients.

Conclusion: Preoperative CT demonstrated good agreement with intraoperative measurements for cusp free margin length in tricuspid valves, although the absolute limits of agreement were wide. CT-based quantification of cusp asymmetry may provide additional information for preoperative surgical planning; however, its association with intraoperative cusp plication remains exploratory and requires validation in larger studies.

Clinical Research Information Service (CRIS) registration number: KCT0006180

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Cite

BibTeXRIS
BibTeX
@article{kim2026quantification,
  title = {{Quantification of Aortic Cusp Parameters Using Computed Tomography in Valve-Sparing Aortic Root Replacement Surgery: A Prospective Study}},
  author = {Hong Rae Kim and Dong Hyun Yang and Joon Bum Kim},
  journal = {Yonsei Medical Journal},
  year = {2026},
  month = sep,
  doi = {10.3349/ymj.2026.0540},
  url = {https://doi.org/10.3349/ymj.2026.0540},
  note = {CC BY-NC 4.0},
}
RIS
TY  - JOUR
TI  - Quantification of Aortic Cusp Parameters Using Computed Tomography in Valve-Sparing Aortic Root Replacement Surgery: A Prospective Study
AU  - Hong Rae Kim
AU  - Dong Hyun Yang
AU  - Joon Bum Kim
PY  - 2026
DA  - 2026/09/04
JO  - Yonsei Medical Journal
DO  - 10.3349/ymj.2026.0540
UR  - https://doi.org/10.3349/ymj.2026.0540
AB  - Purpose: Determining the feasibility of valve-sparing aortic root replacement (VSRR) requires accurate preoperative assessment of aortic valve cusp geometry. However, the reliability of computed tomography (CT) for measuring cusp parameters remains unclear. This study evaluated the agreement between CT-derived cusp measurements and intraoperative measurements and explored the potential of CT-based cusp asymmetry to predict intraoperative cusp plication.  Materials and Methods: In this prospective study, 32 consecutive patients undergoing VSRR with the reimplantation technique were enrolled. Preoperative CT was used to measure cusp free margin length and geometric height. Agreement between CT-derived and intraoperative measurements was assessed using Bland–Altman analysis and intraclass correlation coefficients (ICCs). An exploratory analysis evaluated whether CT-derived cusp asymmetry predicted the need for intraoperative cusp plication.  Results: CT measurements demonstrated good agreement with intraoperative measurements for cusp free margin length (ICC 0.80–0.87). In contrast, geometric height showed only moderate agreement (ICC 0.44–0.69). Exploratory receiver operating characteristic analysis demonstrated moderate discriminative ability of CT-derived cusp asymmetry for predicting intraoperative cusp plication (area under the curve, 0.71; 95% confidence interval, 0.49–0.91), although the association did not reach statistical significance (p=0.06). Postoperative echocardiography demonstrated none-to-mild aortic insufficiency in 96.9% of patients.  Conclusion: Preoperative CT demonstrated good agreement with intraoperative measurements for cusp free margin length in tricuspid valves, although the absolute limits of agreement were wide. CT-based quantification of cusp asymmetry may provide additional information for preoperative surgical planning; however, its association with intraoperative cusp plication remains exploratory and requires validation in larger studies.  Clinical Research Information Service (CRIS) registration number: KCT0006180
SN  - 0513-5796
SN  - 1976-2437
ER  -