Computed Tomography Helps to Plan Minimally Invasive Aortic Valve Replacement Operations.

Area of Science:

• Cardiovascular Surgery
• Medical Imaging
• Thoracic Imaging

Background:

• Minimally invasive aortic valve replacement (MIAVR) offers benefits over traditional sternotomy.
• Accurate preoperative planning is crucial for successful MIAVR outcomes.
• The role of multidetector computed tomography (MDCT) in MIAVR preparation requires evaluation.

Purpose of the Study:

• To assess the impact of preoperative multidetector computed tomography (MDCT) on minimally invasive aortic valve replacement (MIAVR) planning.
• To determine if MDCT influences surgical strategy and intraoperative decisions.
• To identify anatomical predictors for optimal MIAVR access using MDCT.

Main Methods:

• Retrospective analysis of 187 patients undergoing MIAVR.
• Study group (n=86) received preoperative MDCT of thorax, aorta, and femoral arteries.
• Control group (n=101) underwent MIAVR without preoperative MDCT.

Main Results:

• Preoperative MDCT led to significant changes in surgical strategy (12.8% vs. 2.0%, p=0.010).
• Intraoperative strategy modification was noted in controls (9.9%) but not in the MDCT group (p=0.002).
• No conversions to median sternotomy occurred in the MDCT group, versus 4.0% in controls.
• MDCT provided precise measurements for optimal aortic valve access angles and distances.
• Right atrial coverage of aortotomy site was significantly reduced with MDCT-guided second intercostal space access (1.3% vs. 42.9%, p=0.001).

Conclusions:

• Preoperative MDCT of the thorax, aorta, and femoral arteries is valuable for planning MIAVR.
• MDCT aids in optimizing surgical approach and minimizing intraoperative complications.
• This imaging modality enhances patient selection and procedural success in MIAVR.