Short Antero-posterior Distance May Predict Conversion To Sternotomy In Minimally Invasive Cardiac Surgery Through A Right Mini-thoracotomy
Joban S. Bal, Karen E. Joughin, Richard C. Cook.
University of British Columbia, Vancouver, BC, Canada.
Minimally invasive approaches for cardiac surgery are being increasingly used. Pre-operative identification of patients at higher risk of complications may allow for better patient selection. One risk for difficult access to the heart valves through a right mini-thoracotomy incision may be small body habitus, in particular, a short distance between the posterior surface of the sternum, and the anterior aspect of the vertebral body (AP distance).
A retrospective chart review of minimally invasive mini-thoracotomy procedures from March 2015 to May 2019 at Vancouver General Hospital was performed. Eighty six patients who had pre-operative chest CT scans were included. The five patients who were converted to sternotomy were compared to those who were not converted. All CT scans were evaluated and the AP distance at the level of the mitral valve (figure 1) was recorded. Two-sample t-test was used to compare the means of the measures between the groups and two-tailed p-values reported. F-test was used to compare the variances between the groups.
The average age did not differ between groups (60±26.6 years vs 58.9±15.0 years, converted vs not converted, respectively). The AP distance on CT chest was significantly smaller in the group of patients who were converted (9.71±1.88 cm vs 12.18±2.43 cm, P = 0.0287 , converted vs not converted, respectively). There were no peri-operative deaths or strokes or wound infections. Of the patients who were converted to sternotomy, none required mitral valve replacement instead of repair.
We observed that a shorter AP distance on CT chest was associated with the need to convert to a sternotomy in patients undergoing right mini-thoracotomy cardiac surgery. Based on our observations, patients with an AP distance of 8 cm or less are no longer offer a minimally invasive approach because of the high likelihood of conversion to sternotomy.
The level of antero-posterior distance was measured at the level of the mitral valve in CT scans as shown.
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