Morphometric Measurements Prior To Mkr-mic: Technical And Educational Aspects
Wilfried Wisser, Marie-Elisabeth Stelzmüller, Sabine Kappl, Günther Laufer.
Medical University Vienna, Vienna, Austria.
BACKGROUND: Totally endoscopic approach is on the leap to become the new standard in mitral valve surgery. Whereas visualisation with 3D cameras is even superior to conventional surgery, freedom of movements of instruments is reduced, the smaller the incisions are made. Precise planning is a key to achieve excellent results with low conversion and high repair rates. The aim of this study was to develop a morphometric measurement tool for educational purposes to predict operability. METHODS: From 1/2020 to 11/2022, all 68 consecutive patients were scheduled for totally endoscopic mitral valve repair (TE-MVR). 55 patients underwent TE-MVR, 13 patients were deemed to be unsuitable for TE-MVR on clinical and experience grounds because of too narrow space and/or anticipated complex repair techniques. Those underwent repair through sternotomy (MVR-open). All patients underwent routine angio-CT scanning for preoperative planning. On axial view at the level of the midportion of the mitral valve the following measurements have been taken: distance between the sternum and the spine (DSS), distance between skin incision and the anterior anulus of the mitral valve (DNM), the intercostal space at the level of skin incision (ICR). RESULTS: The repair rate in all patients was 100%. In the TE-MVR group the conversion rate to sternotomy was 0%. The 30-day survival was 100 %. In a retrospective analysis the DSS was 129.2 mm and 109.7 mm in the TE-MVR and MVR-open respectively (p<0.001). All other parameters were not statistically significant different. Out of the 55 patients who underwent TE-MVR, 19 patients were found to be technically demanding due to friction and less freedom to move the instruments. Since the morphometric parameters influence each another, a composite parameter was calculated: DSS plus 3xICR minus DNM. It was 37.0, 24.4 and 12.7 for TE-TMR-easy, TE-TMR-demanding and MVR-open respectively (p<0.05 and p<0.01). CONCLUSIONS: Individual surgical skills and long expertise is mandatory to achieve excellent results with low conversion and high repair rate. DSS showed excellent predictability if a totally endoscopic approach was possible. The composite morphometric parameter may be an easy tool for educational demands to predict the ease of TE-MVR.
Back to 2023 ePosters