Computed Tomography For Preoperative Planning In Minimally Invasive Mitral Valve Surgery
Michaela Sasse1, Joon Lee2, Ishtiaq Ahmed2.
1Brighton and Sussex Medical School, Brighton, United Kingdom, 2Royal Sussex County Hospital, Brighton, United Kingdom.
BACKGROUND: Minimally invasive mitral valve surgery (MIMVS) has been developed as an alternative to median sternotomy for the surgical treatment of mitral valve disease. CT plays an important role in patient selection and preoperative planning for MIMVS. This study evaluates our centre’s experience of using CT for preoperative planning in MIMVS to inform future clinical decision making, reduce the risk of complications and highlight important considerations when initiating a MIMVS programme.
METHODS: CT data from all consecutive patients (n = 79) referred for CT evaluation for MIMVS to our centre between January 2016 and February 2021 were retrospectively analysed. All patients underwent a preoperative CT scan to assess suitability for MIMVS. Specific cardiac and vascular parameters were measured on CT. Patient suitability for MIMVS and operative strategy were then discussed by a multidisciplinary heart team.
RESULTS: In total, 79 patients were referred for CT evaluation for MIMVS. A total of 55 patients (69.6%) had MIMVS and 16 patients (20.3%) had a sternotomy. A further 8 patients (10.1%) are still awaiting mitral valve surgery. Overall, 11 patients (13.9%) were excluded from MIMVS due to aberrant CT findings alone. CT exclusion criteria included: significant mitral annular calcification; coronary artery calcification; dilatation of the ascending aorta; significant mural thrombus in the descending and abdominal aorta; slender, calcified iliofemoral vessels; dissection flap in the right external iliac artery; incidental persistent left-sided superior vena cava; significant chest wall deformity (Figure 1A); incidental liver haemangioma; abdominal aortic aneurysm (Figure 1B) and aberrant origin of the left circumflex artery (Figure 1C). Additional CT findings resulted in modification of operative strategy or required further investigation. For MIMVS, the 30-day mortality rate was 0%, the stroke rate was 1.8%, the repair rate was 100% and there were no conversions to sternotomy.
CONCLUSIONS: Preoperative CT plays a crucial role in patient selection and planning for MIMVS and may help reduce the risk of complications. CT can also highlight extra-cardiac findings that may lead to exclusion from MIMVS or require further investigation. Our study demonstrates that MIMVS is a safe and effective procedure. Our study also highlights important considerations when initiating a MIMVS programme. 
LEGEND: Figure 1. Contraindications for minimally invasive mitral valve surgery (MIMVS). 3D CT reconstructions revealing: A) Significant pectus excavatum; B) 4.6 cm abdominal aortic aneurysm and C) Aberrant origin of the left circumflex artery: [1] RCA: Right coronary artery and [2] LCx: Left circumflex artery.
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