Development of Sizing Charts for Optimal Prosthesis Size Selection in Endoscopic Aortic Valve Replacement

All articles of this category (opens in new window) Background: In aortic valve surgery, direct measurement of the sizes for valve replacement in the operating room has so far been standard. However, surgeries have evolved toward minimally invasive, fully endoscopic procedures, which makes intraoperative measurement challenging and cumbersome. The objective of this study was to create sizing charts of surgical bioprosthesis according to patients' annular perimeter. Methods: In our previous research, we have developed a method to digitally simulate aortic valve prostheses in patients’ CT images to facilitate prosthesis selection. However, digital simulation has some limitations due to the differing flexibility of the prostheses. In this study, flexible 3D models were printed from six different patient CT images in various scales (70–130% scale in 5% increments, 12 models per patient), and the perimeters of the aortic valves were measured. Real aortic valve prostheses were implanted into the 3D models, and the appropriate sizes for each perimeter were recorded in a table. Results: The result is an overview table with suitable prostheses for each aortic valve perimeter, consisting of information for different aortic bioprosthesis in sizes 19 to 27 mm. According to our table, Edwards Inspiris valves were suitable for CT-measured annular perimeters of 59.7 to 67.4 mm (19 mm prosthesis), 66.6 to 71.9 mm (21 mm), 70.3 to 82.1 mm (23 mm), 76.4 to 87.4 mm (25 mm), 83.3 to 94.3 mm (27 mm). For Medtronic Avalus valves, prostheses were suitable for perimeters 63.4 to 71.9 mm (19 mm), 69.9 to 78.6 mm (21 mm), 74.7 to 83.7 mm (23 mm), 78.4 to 89.9 mm (25 mm), 83.7 to 98.9 mm (27 mm), respectively. Abbott Epic Max valves were suitable for perimeters 67.0 to 70.9 (19 mm), 70.3 to 74.7 (21 mm), 77.0 to 82.1 mm (23 mm), 80.4 to 89.7 mm (25 mm), 85.9 to 93.3 mm (27 mm), respectively. For Epic Plus Supra valves, perimeter ranges were 59.7 to 67.2 mm (19 mm), 70.9 to 75.2 mm (21 mm), 74.7 to 78.4 mm (23 mm), 78.4 to 85.9 mm (25 mm), 85.9 to 89.7 mm (27 mm). This table is also intended to be made available through an app, where users gain prompt information about the appropriate prosthesis size derived from CT-based perimeter measurements. Conclusion: We developed sizing charts for surgical aortic bioprostheses. This ideally increases patient safety for minimally invasive aortic valve procedures through improved preparation. It may help prevent issues such as patient prosthesis mismatch and other related problems. Publication History Article published online: 17 February 2026 © 2026. Thieme. All rights reserved. Georg Thieme Verlag KG Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany