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. 2023 Oct 24;12(21):6717.
doi: 10.3390/jcm12216717.

Aortic Valve Replacement: Understanding Predictors for the Optimal Ministernotomy Approach

Francesco Giosuè Irace  1 , Ilaria Chirichilli  1 , Marco Russo  1 , Federico Ranocchi  1 , Marcello Bergonzini  1 , Antonio Lio  1 , Francesca Nicolò  1 , Francesco Musumeci  1
Affiliations

Aortic Valve Replacement: Understanding Predictors for the Optimal Ministernotomy Approach

Francesco Giosuè Irace et al. J Clin Med. .

Abstract

Introduction: The most common minimally invasive approach for aortic valve replacement (AVR) is the partial upper mini-sternotomy. The aim of this study is to understand which preoperative computed tomography (CT) features are predictive of longer operations in terms of cardio-pulmonary bypass timesand cross-clamp times.

Methods: From 2011 to 2022, we retrospectively selected 246 patients which underwent isolated AVR and had a preoperative ECG-gated CT scan. On these patients, we analysed the baseline anthropometric characteristics and the following CT scan parameters: aortic annular dimensions, valve calcium score, ascending aorta length, ascending aorta inclination and aorta-sternum distance.

Results: We identified augmented body surface area (>1.9 m2), augmented annular diameter (>23 mm), high calcium score (>2500 Agatson score) and increased aorta-sternum distance (>30 mm) as independent predictors of elongated operation times (more than two-fold).

Conclusions: Identifying the preoperative predictive factors of longer operations can help surgeons select cases suitable for minimally invasive approaches, especially in a teaching context.

Keywords: aortic valve; aortic valve replacement; computed tomography; minimally invasive cardiac surgery.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Flow chart showing the retrospective patient selection.
Figure 2
Figure 2
Example of the CT scan parameters assessed: (1) annular dimensions; (2) calcium score; (3 and 4) aortic annulus inclination angle; (5) ascending aorta length; (6) sternum/STJ distance.
Figure 3
Figure 3
Schematic representation of J-ministernotomy at the 4th intercostal space using a 3D CT reconstruction.
Figure 4
Figure 4
Diagrams showing the distributions of CPB and X-clamp times and the selection of patients are above the 75th percentile (red shadow).
Figure 5
Figure 5
ROC curves for the continuous parameters associated with longer operative times (BSA, annulus diameter, calcium score, sternum/STJ distance); these ROC curves were used to choose the best cut-off points.
See this image and copyright information in PMC

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