• Benjamin Sohmer, Reza Jafar, Prakash Patel, Marie-Ève Chamberland, Michel R Labrosse, and Munir Boodhwani.
• Division of Cardiac Anesthesiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada. Electronic address: bsohmer@ottawaheart.ca.
• J. Cardiothorac. Vasc. Anesth. 2018 Feb 1; 32 (1): 344-351.

ObjectiveThe aim of this study was to test both in humans and using finite element (FE) aortic valve (AV) models whether the coaptation surface area (CoapSA) correlates with aortic insufficiency (AI) severity due to dilated aortic roots to determine the validity and utility of 3-dimensional transesophageal echocardiographic-measured CoapSA.DesignTwo-pronged, clinical and computational approach.SettingSingle university hospital.ParticipantsThe study comprised 10 patients with known AI and 98 FE simulations of increasingly dilated human aortic roots.InterventionsThe CoapSA was calculated using intraoperative 3-dimensional transesophageal echocardiography data of patients with isolated AI and compared with established quantifiers of AI. In addition, the CoapSA and effective regurgitant orifice area (EROA) were determined using FE simulations.Measurements And Main ResultsIn the 10 AI patients, regurgitant fraction (RF) increased with EROA (R2 = 0.77, p = 0.0008); CoapSA decreased with RF (R2 = 0.72, p = 0.0020); CoapSA decreased with EROA (R2 = 0.71, p = 0.0021); and normalized CoapSA (CoapSA / [Ventriculo-Aortic Junction × Sinotubular Junction]) decreased with EROA (R2 = 0.60, p = 0.0088). In the 98 FE simulations, normalized CoapSA decreased with EROA (R2 = 0.50, p = 0.0001).ConclusionsIn both human and FE AV models, CoapSA was observed to be inversely correlated with AI severity, EROA, and RF, thereby supporting the validity and utility of 3D TEE-measured CoapSA. A clinical implication is the expectation that high values of CoapSA, measured intraoperatively after AV repairs, would correlate with better long-term outcomes of those repairs.Copyright © 2018 Elsevier Inc. All rights reserved.

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