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

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 βcoefficient 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.

Aortic Valve Replacement: Understanding Predictors for the Optimal Ministernotomy Approach

“…In 2018, Elattar et al, in their single-centre retrospective study, found that the access angle is strongly associated with procedure complexity; indeed, an access angle of 38 • was a good cut-off to distinguish simple from complex minimally invasive aortic valve replacement [10]; furthermore, in their work, a different kind of angle was considered: Elattar et al considered the angle between the aorta and the surgical access plane, while, in our cohort, we considered the inclination of the aortic annulus on the horizontal plane. On the contrary, Boti et al, in 2019, found that the access angle was not associated with procedure complexity [13].In other recent studies focused on the topic, Jug et al, in 2021, analysed similar anatomical features in the context of anterior mini-thoracotomy or upper mini-sternotomy [14], but they used only rapid-deployment valve prostheses. It is interesting that in their cohort they found that smaller aortic annulus was associated with longer operative times; this difference is probably due to a longer time spent in positioning the sutures with the standard technique in the larger annulus (as in our cohort).…”

Advances in TEE-Centric Intraprocedural Multimodal Image Guidance for Congenital and Structural Heart Disease

“…Interestingly, contrary to prior research, the access angle was not associated with the procedure’s complexity. [ 17 ] 2019 Fluoroscopy This article utilized thermoluminescent dosimeters to measure the radiation exposure across various body regions for patients and operating room medical staff. These findings represent an initial comprehensive comparison of the real-life radiation exposure among operating room personnel and patients when comparing navigation and fluoroscopy usage.…”

“…Interestingly, contrary to prior research, the access angle was not associated with the procedure's complexity. [17] 2019 Fluoroscopy…”

“…The diagnosis of SHD usually requires a variety of imaging tests, including electrocardiography [ 6 ], echocardiography [ 7 ], computed tomography (CT) [ 8 ], magnetic resonance imaging (MRI) [ 8 , 9 ], and invasive cardiac catheterization [ 10 , 11 ]. After diagnosis, SHD is increasingly treated via minimally invasive interventional procedures [ 12 ]—e.g., cardiac catheter occlusion or a closure of defects [ 13 ], valve replacement or repair, etc.—under imaging guidance [ 14 , 15 , 16 , 17 ]. In a well-planned and executed cardiac catheterization procedure, imaging is fundamental for all aspects of the transcatheter treatment process, including pre-procedural planning, the assessment of the extent of the disease, diagnosing and detecting risk factors, and intraoperative guidance, as shown in Figure 1 .…”

Multidetector computed tomography in the selection of the optimal surgical approach to the replacement of the aortic valve

“…The outer contour of the heart is formed by the pericardium and a strip of epicardial fat. The pericardium attaches to large vessels at the level of the aortic arch, forming a kind of "bag", the contents of which are the heart, adipose tissue and parts of large vessels emanating from the heart or flowing into it (15). To determine optimal surgical access, the most important is to obtain dynamic computed tomography angiography images at70% of the cardiac cycle (middiastole) because in this phase the aortic valve is closed (16).…”