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Advanced Ct-derived analysis to optimize preoperative surgical planning in patients undergoing minimally invasive cardiac surgery procedures.
Pasquale Totaro, Alessandro Mazzola.
Cardiothoracic Surgery,IRCCS Foundation San Matteo, Pavia, Italy.

The evolution of imaging technologies and post-processing tools allow a real useful support during surgical operation planning. CT imagines have become the gold standard for the diagnosis and the evaluation of several cardio-thoracic diseases. The introduction of several dedicated software furthermore has enhanced the three-dimensional reconstruction of chest structures allowing a real improvement in preoperative evaluation and surgical planning in patients undergoing cardiac surgery. Here we present our original multidisciplinary approach to optimize preoperative surgical planning.
Materials and Methods
Patients undergoing cardiothoracic surgery procedures with a proposed minimally invasive approach undergo synchronized multisliced CT scan of the chest with three-dymensional reconstruction. Following a primary discussion between the radiologist and the surgeon the imagines are uploaded in the general system and the surgeon further analyze them in co-operation with the engeneering department in order to create ad-hoc reconstructions to support the preoperative surgical planning. This is accomplished with the primary identification (Fig 1A) of the useful surgical spots (i.e. aortic and atrial cannulation sites, clamp position, site of aortotomy and atriotomy) using free imaging softwares (e.g., Osirix). The safety and usefully of different minimally invasive approaches can be then simulated using computational programmes (e.g., Matlab) as shown in fig 1b/c
Application of such technologies and a structurate protocol allows obtaining useful information in preoperative surgical planning process. As results of such combined protocol we were able preoperatively to either confirm the level of minimally invasive approach (45% pts) modify the level confirming minimally invasive approach (35% pts) or even abandon the indication for minimally invasive approach (20%).
The application of modern technologies and updated software to achieve the optimal mixture between fine diagnostic experiments and real clinical advantages require the multidisciplinary interest and a true co-operation. Current available software allows obtaining an advanced preoperative surgical planning and should be used to optimize the surgeon decision making.

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