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An Anatomical Study of Nerves at Risk During Minimally Invasive Hallux Valgus Surgery
Published on: February 17, 2018
Systematic preoperative CT scan is associated with reduced risk of stroke in minimally invasive mitral valve surgery:
Jeremy R Leonard1, Matthew Henry1, Mohamed Rahouma1
1Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York City, NY, USA.
Background:
Minimally invasive mitral valve surgery (MIMVS) is performed with increasing frequency. However, patients undergoing MIMVS might be at increased risk of perioperative stroke, mainly due to retrograde aortic embolization during femoral cardio-pulmonary bypass. Pre-operative computed tomography (CT) screening allows visualization of the aorta and femoro-iliac vessels and individualization of the surgical approach. In this meta-analysis, we aim to determine if systematic pre-operative CT screening is associated with decreased incidence of post-operative stroke and other complications following MIMVS.
Methods:
A comprehensive review was performed in PubMed (inception-May 2018). Eligible studies included those which reported on MIMVS (mini-thoracotomy, port access or robotic approach) with retrograde arterial perfusion. Studies were separated into two subgroups: systematic pre-operative CT screening (CT-group) and no CT screening (Non-CT). Pooled event rates (PER) for operative mortality, post-operative stroke, perioperative myocardial infarction (MI), and new onset renal failure requiring dialysis were estimated and inter-group comparisons were performed.
Results:
Data from 57 studies (13,731 patients) were analyzed (19 CT-group, 38 Non-CT). PER for post-operative stroke was 2.0% with a statistically significant difference between the groups (CT-group: 1.5% versus Non-CT: 2.2%, P = 0.03). PER for new dialysis was 1.9%, significantly lower in the CT-group (0.8% versus 2.3% in the Non-CT group, P = 0.02). PER for operative mortality was 1.4% with a trend towards better outcomes in the CT-group (0.8% versus 1.6% in the Non-CT group, P = 0.05).
Conclusions:
Systematic pre-operative CT screening is associated with lower risk of post-operative stroke and need for dialysis and a trend toward lower operative mortality after MIMVS.
Insights
Systematic pre-operative CT screening before minimally invasive mitral valve surgery significantly reduces stroke and dialysis risks. This approach also shows a trend toward lower operative mortality, improving patient outcomes.
Area of Science:
- Cardiovascular Surgery
- Medical Imaging
- Health Outcomes Research
Background:
- Minimally invasive mitral valve surgery (MIMVS) is increasingly common.
- Patients undergoing MIMVS face elevated perioperative stroke risk, often from retrograde aortic embolization during femoral cardiopulmonary bypass.
- Pre-operative computed tomography (CT) screening aids in visualizing the aorta and femoro-iliac vessels, enabling personalized surgical planning.
Purpose of the Study:
- To determine if systematic pre-operative CT screening reduces post-operative stroke incidence in MIMVS.
- To assess the impact of CT screening on other complications, including operative mortality and renal failure.
Main Methods:
- A meta-analysis of studies published in PubMed (inception-May 2018) was conducted.
- Studies involving MIMVS with retrograde arterial perfusion were categorized into systematic pre-operative CT screening (CT-group) and no CT screening (Non-CT) groups.
- Pooled event rates for operative mortality, post-operative stroke, myocardial infarction, and new-onset renal failure requiring dialysis were calculated and compared between groups.
Main Results:
- Analysis of 57 studies (13,731 patients) revealed a significantly lower post-operative stroke rate in the CT-group (1.5%) compared to the Non-CT group (2.2%; P=0.03).
- The incidence of new dialysis requirement was also significantly lower in the CT-group (0.8% vs. 2.3%; P=0.02).
- Operative mortality was 1.4% overall, with a trend towards better outcomes in the CT-group (0.8% vs. 1.6%; P=0.05).
Conclusions:
- Systematic pre-operative CT screening is associated with a reduced risk of post-operative stroke after MIMVS.
- CT screening also correlates with a lower need for dialysis and a trend toward decreased operative mortality.
- These findings support the utility of pre-operative CT screening for optimizing patient safety in MIMVS.
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