Influence Of Preoperative Computed Tomography On The Operative Strategy During Minimally Invasive Mitral Surgery
Pierre Demondion, Christophe Heylbroeck, An-Thai Le, Gabriel Mercier, Hugues Jeanmart.
Sacré Coeur Hospital, Montréal, QC, Canada.
Minimally invasive mitral surgery (MIMS) has become a regular approach in many centers across the globe but different opinions exist on the usefulness of preoperative computed tomography (CT) to plan these surgeries. The aim of this study was to evaluate the influence of preoperative CT use in the operative planning for MIMS.
From 2007 to 2016, 222 consecutive patients were operated for an isolated MS by a single surgeon in our center. Of those patients, 202 patients were evaluated with a CT for a minimally invasive approach and their files were retrospectively reviewed to look for the influence of the CT results on their operative planning.
Of the 202 patients evaluated, 22 patients (10.1 %) had a contraindication, identified on the preoperative CT, to undergo a minimally invasive approach through the right chest. Reasons were the following: vascular disease or aortic thrombus (n=11, 50%), leaking mammary prosthesis (n=5, 22.5 %), chest deformity without enough working space (n=1, 4.5 %) and significant right pleural scarring due to previous surgery (n=5, 22.5 %). For the 158 patients who underwent a minimally invasive approach, 22 patients (13.9 %) needed a modification of the preoperative strategy secondary to findings on the CT-scan: modification of cannulation site in 15 patients (77.3 %) or type of aortic occlusion for 5 patients (22.7 %). One hundred and thirty-two patients underwent mitral valve repair (84%) and 26 mitral vale replacement (16%). With these modifications, operative results were the following: repair rate 99.3 %, mortality 1.2 %, conversion rate 2.4 %, stroke 1.8 %, vascular injury 0.8 %. All the patients left the hospital with no or trivial residual mitral regurgitation.
In 20 % of patients evaluated for MIMS, preoperative CT influence the operative strategy. These modifications in operative strategy allowed us to have excellent clinical outcomes with this procedure. So, a systematic and thorough preoperative screening looking for anatomical or vascular contraindications is the cornerstone to safely perform MIMS.
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