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. 2019 Oct 12;14(1):173.
doi: 10.1186/s13019-019-0997-5.

Minimal invasive aortic valve replacement: associations of radiological assessments with procedure complexity

Bruce R Boti  1   2   3 , Vikash G Hindori  4 , Emilio L Schade  5 , Athina M Kougioumtzoglou  5 , Eva C Verbeek  4 , Annet Driessen-Waaijer  6 , Riccardo Cocchieri  4 , Bas A J M de Mol  5 , Nils R Planken  7 , Abdullah Kaya  5 , Henk A Marquering  8   7
Affiliations

Minimal invasive aortic valve replacement: associations of radiological assessments with procedure complexity

Bruce R Boti et al. J Cardiothorac Surg. .

Abstract

Objectives: Limited aortic annulus exposure during minimal invasive aortic valve replacement (mini-AVR) proves to be challenging and contributes to procedure complexity, resulting in longer procedure times. New innovations like sutureless valves have been introduced to reduce procedure complexity. Additionally, preoperative imaging could also contribute to reducing procedure times. Therefore, we hypothesize that Computed Tomography (CT)-image based measurements are associated with mini-AVR complexity.

Methods: One hundred patients who underwent a mini-sternotomy and had a preoperative CT scan were included. With a CT-based mini-AVR planning tool, we measured access distance, access angle, annulus dimensions, and calcium volume. The associations of these measurements with cardiopulmonary bypass (CPB) time and aortic cross-clamp (AoX) time were assessed using univariable and multivariable regression models. In the multivariable models, these measurements were adjusted for age and suture technique.

Results: In the univariable regression models, calcium volume and annulus dimensions were associated with longer CPB and AoX time. After adjusting for age and suture technique, increasing calcium volume was still associated with longer CPB (adjusted β-coefficient 0.002, 95%-CI (0.005, 0.019), p-value = 0.002) and AoX time (adjusted β-coefficient 0.010, 95%-CI (0.004, 0.016), p-value = 0.002). However, after adjusting for these confounders, the association between annulus dimensions and procedure times lost statistical significance.

Conclusion: Increase in calcium volume are associated with longer CPB and AoX times, with age and sutureless valve implantation as independent confounders. In contrast to previous studies, access angle was not associated with procedure complexity.

Keywords: Aortic valve replacement; Computed tomography; Imaging; Minimal invasive surgery.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
a Anterior (surgical) view of the aorta and ribcage. b Laterosuperior view of the aorta and partial rib cage. The access distance and access angle are determined based on the location of three landmarks: aortic annulus center, sinotubular junction and incision location (manubriosternal joint)
Fig. 2
Fig. 2
Screenshot of the mini-AVR planning tool. The graphical user interface (GUI) shows the isocontours of the access distance and access angle. The access angle contours are colorized ranging from dark green (small angle) to white (large angle). The access distance contours are colorized ranging from dark blue (short distance) to white (long distance). The quantitative measures are displayed in the legend on the right: the left column of bars for angles and right column for distance
See this image and copyright information in PMC

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