International Society For Minimally Invasive Cardiothoracic Surgery

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Variable Importance Analysis In Endoscopic Mitral Valve Surgery
Rafik Margaryan, Giacomo Bianchi, Tommaso Gasbarri, Marco Solinas.
Ospedale Del Cuore Fondazione 'G. Monasterio', Massa, Italy.

ObjectiveEndoscopic mitral valve surgery is a relatively new procedure and preparation and right intercostal space are crucial for success. We aimed to explore clinical variables in order to find most important variable in predicting aortic cross-clamping (XC) time, cardiopulmonary bypass (CPB) time and time difference between CPB and XC (practically speaking on pump preparation time).Methods Overall 240 patients underwent fully endoscopic mitral valve surgery. Mean age was 61.1 11.9 and 31.25 % were female patients. We have considered all intraoperative variable and created predictive model (cross validating and the best model selected from many of them; algorithm was Random Forest) which could predict the outcome most accurately. The using the variable importance importance (as a highest possible predicative value) we have separated the then of them for every outcome variable: aortic cross clamping time, cardio-pulmonary bypass time, and preparation time. From the best-performing classifier we have chosen and the best model and separated five important variable from the for every outcome.ResultsThe importance variable analysis showed that mitral valve replacement was the most important variable as for predicting aortic cross clamping time follwo by annuloplasty, hight of the patient, neochordae and mitral annulus size (see Figure 1 and Table 1), mitral vlave replacemet for the overall cross clamping time followed by annuloplasty preparing surgeon, mitral annulus size and 3D vidiescoopy, and preparing surgeon followed by weight of the patient, chest deepness, Cor Knot device and chordae hiden in the ventricle.ConclusionNew procedure or setup variable analysis is important. Variable importance determination could shed light on how to decrease the XC and CPB time. The most complex variable for endoscopic mitral valve is mitral valve replacemet. Other variable importance is crucial for procedure fine tuning and perfection.

Table 1
CX VariablesCX PercentageCPB VariableCPB PercentagePP VariablePP Percentage
MV replacement100.0MV replacement100.0Preparing Surgeon100.0
Annuloplasty95.5Annuloplasty96.0Weight33.2
Hight63.6Preparing Surgeon85.4Chest Deepness28.3
Neochorde61.9Mitral Annulus Size61.2Cor Knot Device26.5
Mitral Annulus Size55.43D Vidiescopy51.9Chordae Hide In The Ventricle26.3


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