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Preoperative CTA prevents Stroke in MICS
Atiq Rehman.
Sarasota Memorial Hospital, Sarasota, FL, USA.

Objective:
Stroke is one of the most devastating complications of Cardiac Surgery. We proceeded to evaluate the role of Computerized Tomographic Angiography in patients undergoing minimally invasive cardiac surgery (MICS)
Methods:
Retrospective review of 213 MICS performed by a single surgeon at a single institution over a period of 36 months and evaluation for cerebral events with a permanent deficit. A protocol has been developed at our institution whereby all patients undergoing MICS i.e. minimally invasive aortic or mitral valve surgery or robotic assited valvular or coronary artery bypass surgery will have a CTA performed to rule extensive arterial calcification and the assessment of caliber of the vessels.
Results:
In this series of 213 patients, there were 72 minimally invasive aortic valves (mAVR), 73 minimally invasive mitral valves (mMVR), 47 robotic assisted CABG performed and the rest of the 21 patients were miscellaneous including minimally invasive pulmonary valve replacement, removal of Tricuspid valve Fibroelastoma, etc. 40% of these patients were > 75 years of age. In every case, when there were extensive calcifications identified on CTA, we would change the arterial inflow site from femoral to right axillary approach (10% cases).
There was only one single major stroke in an 84 year of old with permanent right sided hemiplegia. There were two other patients with a transient neurologic deficit but with full recovery.
Conclusions:
Preoperative CTA helps identify patients at high risk for stroke, especially in the elderly population. It should be an essential part of the work up of all patients undergoing MICS.


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