Aortic Valve Replacement: Understanding Predictors for the Optimal Ministernotomy Approach.

Area of Science:

• Cardiovascular Surgery
• Medical Imaging
• Thoracic Surgery

Background:

• Partial upper mini-sternotomy is a common minimally invasive approach for aortic valve replacement (AVR).
• Predicting operation duration is crucial for surgical planning and patient selection.
• Understanding preoperative computed tomography (CT) features can optimize surgical strategy.

Purpose of the Study:

• To identify preoperative CT scan features that predict longer cardiopulmonary bypass and cross-clamp times during AVR.
• To enhance the selection of suitable candidates for minimally invasive AVR procedures.

Main Methods:

• Retrospective analysis of 246 patients undergoing isolated AVR from 2011 to 2022 with preoperative ECG-gated CT scans.
• Evaluation of anthropometric characteristics and CT parameters including aortic annular dimensions, valve calcium score, ascending aorta length, inclination, and aorta-sternum distance.

Main Results:

• Augmented body surface area (>1.9 m²), increased aortic annular diameter (>23 mm), high valve calcium score (>2500 Agatson score), and greater aorta-sternum distance (>30 mm) were identified as independent predictors.
• These factors were associated with more than a two-fold increase in operation times.

Conclusions:

• Preoperative CT features can predict prolonged operation times in AVR patients.
• Identifying these predictors assists surgeons in selecting appropriate cases for minimally invasive approaches, particularly in educational settings.