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Impact of standardized computed tomographic angiography for minimally invasive mitral and tricuspid valve surgery

Moritz B Immohr1, Yukiharu Sugimura1, Patric Kröpil2

  • 1Department of Cardiac Surgery, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Moorenstr. 5, 40225, Düsseldorf, Germany.

Journal of Cardiothoracic Surgery
|March 21, 2021
PubMed

Insights

Preoperative computed tomography-angiography (CT-A) for minimally invasive cardiac surgery (MICS) identifies vascular pathologies, reducing complication risks. This imaging protocol customizes operative strategies for safer extracorporeal circulation (ECC) via femoral arteries.

Area of Science:

  • Cardiovascular Surgery
  • Medical Imaging
  • Vascular Surgery

Background:

  • Femoral cannulation is standard for extracorporeal circulation (ECC) in minimally invasive cardiac surgery (MICS).
  • Vascular pathologies pose significant risks during femoral cannulation.
  • Preoperative computed tomography-angiography (CT-A) of the aorta and iliac arteries was implemented.

Purpose of the Study:

  • To evaluate the utility of CT-A in identifying vascular pathologies before MICS.
  • To assess the impact of CT-A on complication rates during ECC.
  • To determine if CT-A can guide customized cannulation strategies.

Main Methods:

  • Retrospective review of 143 MICS cases between July 2017 and December 2018.
  • Patients divided into three groups: no CT, non-contrast CT, and CT-angiography (CT-A).
  • Analysis of vascular complications and cannulation strategies based on imaging findings.

Main Results:

  • Patients without CT had a 6.7% complication rate. Non-contrast CT showed a 11.4% complication rate.
  • CT-A identified significant pathologies in 19.0% (vulnerable plaques), 11.1% (kinking), 65.1% (calcified plaques), and 7.9% (small diameter).
  • CT-A led to alternative cannulation in 11.1% (axillary) and 6.3% (left femoral), with only a 3.2% complication rate.

Conclusions:

  • CT-A effectively identifies vascular pathologies not detected by routine preoperative assessment.
  • Implementing a standardized CT-A protocol can personalize surgical strategies.
  • CT-A improves safety by enabling tailored cannulation approaches for MICS.
Abstract

Keywords:
CT protocolCT-angiographyCalcificationMinimally invasive cardiac surgeryMitral valvePreoperative screeningVulnerable plaques

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