Eligibility for minithoracotomy aortic valve replacement: from Van Praet classification to complex scanner...

Area of Science:

• Cardiovascular Surgery
• Medical Imaging

Background:

• Minithoracotomy aortic valve replacement (MT-AVR) offers a less invasive approach for aortic valve disease.
• Predicting surgical difficulty is crucial for patient selection and procedural success.
• The Van Praet classification uses aortic position to assess MT-AVR feasibility.

Purpose of the Study:

• To evaluate the utility of complex computed tomography (CT) measurements in predicting the ease of MT-AVR.
• To correlate CT-derived aortic measurements with surgical durations in MT-AVR.
• To validate the Van Praet classification for patient selection in MT-AVR.

Main Methods:

• Analysis of preoperative CT scans from 57 patients undergoing MT-AVR (February 2018 - June 2020).
• Patients were pre-selected based on Van Praet classes IA and IB.
• Complex CT measurements of aortic position and aorto-sternal angle were correlated with operative times.

Main Results:

• Van Praet criteria correlated significantly with aortic position relative to the midline and aorto-sternal angle.
• No significant correlation was found between complex CT measurements and surgical step durations for Van Praet classes IA and IB.
• All patients in the cohort successfully underwent MT-AVR without conversion.

Conclusions:

• The Van Praet classification is sufficient for determining MT-AVR eligibility, even for surgeons new to the procedure.
• Complex CT measurements do not provide incremental value in predicting surgical difficulty for MT-AVR.
• Preoperative assessment using the Van Praet classification aids in successful MT-AVR outcomes.