CT-based evaluation of thoracic anatomy in AS vs AR patients undergoing MIAVR

In this study, the difference in anatomical variables was considered between Aortic stenosis (AS) and Aortic regurgitation (AR) groups by preoperative computed tomography (CT) in minimally invasive cardiac surgery for aortic valve replacement (MIAVR).

Patients who underwent AVR between 2012 and 2021 at our center were retrospectively analyzed in two groups, AS and AR. The final 278 samples possessed detailed clinical information of the patients. The six items were measured in preoperative CT and compared in significant difference in number.

No significant differences were found in the patients' characteristics between the AS and AR groups except for age, sex and body surface area. The number of younger and male patients was higher in the AR group than in the AS group (P <  0.01), including a larger body surface area (P <  0.01). The AR group had larger rightward laterality aorta and third ICS (AS vs AR - 3.9 ± 8.9 vs 0.6 ± 8.9 mm, P < 0.01; 14.2 ± 1.3 vs 15 ± 1.6 cm, P <  0.01, respectively).

Preoperative CT revealed thoracic anatomical differences between AS and AR patients undergoing MIAVR. Although no direct correlation with cross-clamp time was observed except for AP distance in both AR and AS, surgeons should be aware that these anatomical features-particularly the rightward aorta and deeper and more caudally positioned AV in AR patients to make surgical decision making, surgical planning. CT-based evaluation is a valuable tool for guiding approach strategy and patient selection in MIAVR.