Impact of standardized computed tomographic angiography for minimally invasive mitral and tricuspid valve surgery

Journal of Cardiothoracic Surgery

Alexander Albert¹  Artur Lichtenberg¹  Moritz B. Immohr¹  Hug Aubin¹  Payam Akhyari¹  Yukiharu Sugimura¹  Udo Boeken¹  Patric Kröpil²  Jan-Philipp Minol³ 

[1] Department of Cardiac Surgery, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Moorenstr. 5, 40225, Düsseldorf, Germany;Department of Radiology, BG Klinikum Duisburg, Großenbaumer Allee 250, 47249, Duisburg, Germany;Department of Vascular and Endovascular Surgery, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Moorenstr. 5, 40225, Düsseldorf, Germany;

关键词: Minimally invasive cardiac surgery;    Mitral valve;    CT-angiography;    Calcification;    Vulnerable plaques;    CT protocol;    Preoperative screening;   

DOI  :  10.1186/s13019-021-01400-6

来源: Springer

【 摘 要 】

BackgroundFemoral cannulation for extracorporeal circulation (ECC) is a standard procedure for minimally invasive cardiac surgery (MICS) of the atrio-ventricular valves. Vascular pathologies may cause serious complications. Preoperative computed tomography-angiography (CT-A) of the aorta, axillary and iliac arteries was implemented at our department.MethodsBetween July 2017 and December 2018 all MICS were retrospectively reviewed (n = 143), and divided into 3 groups.ResultsIn patients without CT (n = 45, 31.5%) ECC was applied via femoral arteries (91.1% right, 8.9% left). Vascular related complications (dissection, stroke, coronary and visceral ischemia, related in-hospital death) occurred in 3 patients (6.7%). In patients with non-contrast CT (n = 35, 24.5%) only femoral cannulation was applied (94.3% right) with complications in 4 patients (11.4%). CT-angiography (n = 63, 44.1%) identified 12 patients (19.0%) with vulnerable plaques, 7 patients (11.1%) with kinking of iliac vessels, 41 patients (65.1%) with multiple calcified plaques and 5 patients (7.9%) with small femoral artery diameter (d ≤ 6 mm). In 7 patients (11.1%) pathologic findings led to alternative cannulation via right axillary artery, additional 4 patients (6.3%) were cannulated via left femoral artery. Only 2 patients (3.2%) suffered from complications.ConclusionsCT-A identifies vascular pathologies otherwise undetectable in routine preoperative preparation. A standardized imaging protocol may help to customize the operative strategy.

【 授权许可】

CC BY