CT-Based Annular Measurements as a Predictor for Perceval Valve Size Selection

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OBJECTIVE: This multicenter study evaluates the accuracy of preoperative multidetector computed tomography (MDCT) measurements in predicting the appropriate Perceval (CORCYM Srl, Milan, Italy) prosthesis size, developing a chart to support surgeons in identifying the correct valve size. METHODS: A multicenter retrospective study was conducted across 15 centers in 10 different countries. Inclusion criteria included preoperative MDCT imaging, meeting standardized technical specifications, and early postoperative clinical and hemodynamic outcomes, meeting the expected outcomes of a correctly sized valve. The K-means and receiver operating characteristic (ROC) analysis were applied to evaluate the sizing chart on 70% of the population, and their accuracy was verified on the remaining 30%. RESULTS: There were 338 patients (mean age = 72.8 ± 7.9 years, 50.6% male) analyzed for this study, with a distribution of implanted bioprosthetic valve sizes of small in 21.6%, medium in 39.6%, large in 26.0%, and extra-large in 12.7%. The perimeter-derived diameter was found to be the MDCT-derived anatomical parameter with best overall correlation with the prosthesis size, and the K-means method outperformed the ROC curve-based classification, with an accuracy of prediction at almost 70%. CONCLUSIONS: The analysis of CT-based annular measurements as a predictive tool for Perceval valve sizing represents a meaningful step forward in contemporary cardiac surgery. In our retrospective, multicenter, real-world cohort, preoperative aortic annulus dimensions obtained via MDCT showed a moderate predictive accuracy for tricuspid aortic valves, and intraoperative assessment remains essential. Future larger studies, improved MDCT quality, and artificial intelligence tools may help refine and improve predictive performance, also in bicuspid anatomies.

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