Computed tomography-based prediction of commissural positions facilitates valve-sparing aortic root replacement.

Objectives: This study aimed to compare aortic root reimplantation planning using computed tomography (CT) with conventional methods and to assess the accuracy of automated CT measurements using a deep-learning algorithm. Methods: Twenty patients underwent David reimplantation at our hospital with CT-based planning to determine graft sizes from virtual basal ring dimensions and predict commissural positions using electrocardiogram-gated CT. In the controls (n = 20), preoperative transesophageal echocardiography determined virtual basal ring sizing, whereas surgeons intraoperatively assessed commissural positions. We also analyzed correlations between CT measurements obtained manually by experts and automatically by our deep-learning-based algorithm using 50 cases indicated for David reimplantation. Results: The CT group had a shorter aortic crossclamp time ( Conclusions: For David reimplantation, CT-based planning of graft sizes and commissural positions may reduce the need for intraoperative commissural position adjustments and cusp repair. Our deep learning-based algorithm can replace expert measurements in standardized surgical planning.