title: Preoperative multidetector computed tomograpy angiography for planning of minimally invasive robotic mitral valve surgery: impact on decision making.
abstract: BACKGROUND
  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.
authors: Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio 44195, USA.
authors: Sashidaran
authors: S
authors: Moodley
authors: Paul
authors: P
authors: Schoenhagen
authors: A Marc
authors: AM
authors: Gillinov
authors: Tomislav
authors: T
authors: Mihaljevic
authors: Scott D
authors: SD
authors: Flamm
authors: Brian P
authors: BP
authors: Griffin
authors: Milind Y
authors: MY
authors: Desai
mesh_terms: D000328:Adult; D000368:Aged; D001018:Aortic Diseases / Q000000981:diagnostic imaging; D001027:Aortography / Q000379:methods*; D050197:Atherosclerosis / Q000000981:diagnostic imaging; D006348:Cardiac Surgical Procedures / Q000009:adverse effects; D016009:Chi-Square Distribution; D003287:Contrast Media; D005260:Female; D006801:Humans; D007083:Iliac Artery / Q000000981:diagnostic imaging; D021621:Imaging, Three-Dimensional; D007472:Iohexol / Q000031:analogs & derivatives; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D008943:Mitral Valve / Q000000981:diagnostic imaging* / Q000601:surgery*; D008944:Mitral Valve Insufficiency / Q000000981:diagnostic imaging* / Q000601:surgery*; D061330:Multidetector Computed Tomography; D015999:Multivariate Analysis; D018579:Patient Selection; D011237:Predictive Value of Tests; D011300:Preoperative Care; D011857:Radiographic Image Interpretation, Computer-Assisted; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012371:Robotics; D012720:Severity of Illness Index; D025321:Surgery, Computer-Assisted / Q000009:adverse effects
chemical_list: D003287:Contrast Media; D007472:Iohexol; C038192:iopromide