The Evaluation For Safety Of Minimally Invasive Mitral Valve Repair: Preoperative Assessment Of The Shape Of The Thorax
Yasushi Yoshikawa, Koichi Toda, Shigeru Miyagawa, Hiroki hata, Shunsuke Saito, Keitaro Domae, Noriyuki Kashiyama, Yoshiki Sawa.
Osaka University Graduate School of Medicine, Suita, Japan.
OBJECTIVE: Minimally invasive approaches (MICS) to mitral valve surgery have prevailed recently, but have potential pitfalls because of limited operative field. Clinical outcomes should not be compromised at the cost of smaller incision. To ensure the safety, acquirement of good operative field is mandatory, but unexpected bad operative fields are sometimes encountered. This time, we focused on the shape of the thorax and anticipated whether good operative fields were acquired or not.
METHODS: Between 2011 and December 2016, 90 MICS-MVPs were performed. The distance between sternum and vertebrae (DSV) and the aspect ratio of the thorax (length-to-width ratio) (ART) were evaluated by enhanced CT preoperatively, and the difficulty of operative field acquirement were evaluated.
RESULTS: No conversion to full sternotomy was recognized. Mitral valve repairs were successfully done in all cases. The average DSV was 10.0±1.8cm (female 8.7±1.6, male 11.0±1.4). The average ART was 0.72±0.08 (female 0.75±0.08, male 0.71±0.08). Eight cases had less than 7.5cm DSV and 5 of 8 cases had poor operative fields in anterior-to-posterior direction. Five cases had less than 0.6 ART and all these cases had poor operative fields in trigone-to-trigone direction.
CONCLUSIONS: The cases who had less than 7.5cm DSV, so called flat chest, and who had less than 0.6 ART, so called barrel chest, tended to have poor operative fields. It was considered that the criteria as over 7.5cm DSV and over 0.6 ART was the threshold of acquisition of good operative fields.
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