Minimally invasive mitral valve (MV) surgeries (ie, right thoracotomy and robotic approaches) are preferred for degenerative mitral regurgitation because these procedures result in reduced surgical trauma and recovery time. However, because of peripheral cardiopulmonary bypass, there is risk of embolic complications. We sought to use the strengths of 3-dimensional multidetector computed tomography (MDCT) in assessing aortoiliac atherosclerosis and mitral annular calcification (MAC) and its influence on decision for approach in MV surgery.
Methods
We included 141 patients with isolated grade 3 or 4+ mitral regurgitation who underwent contrast-enhanced MDCT of the chest, abdomen, and pelvis. Aortoiliac atherosclerosis was measured as circumferentiality (0 = none, 1 = less than one third, 2 = one third to two thirds, and 3 = more than two thirds) and thickness (0 = none or <1 mm, 1 = 1 to 2.9 mm, 2 = 3 to 5 mm, and 3 = >5 mm). Significant atherosclerosis was defined as circumferentiality score ≥1 and/or thickness score ≥1. Circumferentiality of MAC was also measured in a similar manner. Change in surgical approach was considered if a full/partial sternotomy was performed or surgical procedure was cancelled.
Results
One hundred eleven (79%) patients (mean age, 54 ± 11 years; 67% men) underwent minimally invasive MV repair, whereas 30 patients (21%) had surgical approach changed (1 surgical cancellation). Of 111 patients who underwent minimally invasive repair, 4 (3.6%) patients had significant atherosclerosis/MAC, whereas 26 (87%) patients had evidence of significant atherosclerosis/MAC in the changed approach group.
Conclusions
In patients undergoing minimally invasive MV surgery, there is a strong association between presence of significant aortoiliac atherosclerosis, as determined by MDCT and/or MAC and change in surgical approach.
Abbreviations and Acronyms
CT
computed tomography
ECG
electrocardiogram
MDCT
multidetector computed tomography
MR
mitral regurgitation
MV
mitral valve
CTSNet classification
28
35
36
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Disclosures: Authors have nothing to disclose with regard to commercial support.