title: Computed Tomography Helps to Plan Minimally Invasive Aortic Valve Replacement Operations.
abstract: BACKGROUND
  This study evaluated the role of multidetector computed tomography (MDCT) in preparation for minimally invasive aortic valve replacement (MIAVR).
  
  
  METHODS
  An analysis of 187 patients scheduled for MIAVR between June 2009 and December 2014 was conducted. In the study group (n = 86), MDCT of the thorax, aorta, and femoral arteries was performed before the operation. In the control group (n = 101), patients qualified for MIAVR without receiving preoperative MDCT.
  
  
  RESULTS
  The surgical strategy was changed preoperatively in 12.8% of patients from the study group and in 2.0% of patients from the control group (p = 0.010) and intraoperatively in 9.9% of patients from the control group and in none from the study group (p = 0.002). No conversion to median sternotomy was necessary in the study group; among the controls, there were 4.0% conversions. On the basis of the MDCT measurements, optimal access to the aortic valve was achieved when the angle between the aortic valve plane and the line to the second intercostal space was 91.9 ± 10.0 degrees and to the third intercostal space was 94.0 ± 1.4 degrees, with the distance to the valve being 94.8 ± 13.8 mm and 84.5 ± 9.9 mm for the second and third intercostal spaces, respectively. The right atrium covering the site of the aortotomy was present in 42.9% of cases when MIAVR had been performed through the third intercostal space and in 1.3% when through the second intercostal space (p = 0.001).
  
  
  CONCLUSIONS
  Preoperative MDCT of the thorax, aorta, and femoral arteries makes it possible to plan MIAVR operations.
authors.affiliation: Department of Cardiovascular Surgery and Transplantology, Jagiellonian University in Cracow, John Paul II Hospital, Cracow, Poland. Electronic address: jstolinski@gmail.com.
authors.forename: Jarosław
authors.initials: J
authors.lastname: Stoliński
authors.affiliation: Department of Cardiovascular Surgery and Transplantology, Jagiellonian University in Cracow, John Paul II Hospital, Cracow, Poland.
authors.forename: Dariusz
authors.initials: D
authors.lastname: Plicner
authors.affiliation: Department of Cardiovascular Surgery and Transplantology, Jagiellonian University in Cracow, John Paul II Hospital, Cracow, Poland.
authors.forename: Grzegorz
authors.initials: G
authors.lastname: Grudzień
authors.affiliation: Department of Cardiovascular Surgery and Transplantology, Jagiellonian University in Cracow, John Paul II Hospital, Cracow, Poland.
authors.forename: Paweł
authors.initials: P
authors.lastname: Kruszec
authors.affiliation: Department of Statistics, Cracow University of Economics, Cracow, Poland.
authors.forename: Kamil
authors.initials: K
authors.lastname: Fijorek
authors.affiliation: Department of Anesthesiology and Intensive Therapy, Jagiellonian University in Cracow, John Paul II Hospital, Cracow, Poland.
authors.forename: Robert
authors.initials: R
authors.lastname: Musiał
authors.affiliation: Department of Anesthesiology and Intensive Therapy, Jagiellonian University in Cracow, John Paul II Hospital, Cracow, Poland.
authors.forename: Janusz
authors.initials: J
authors.lastname: Andres
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001011:Aorta / Q000000981:diagnostic imaging; D001021:Aortic Valve / Q000601:surgery*; D005260:Female; D005263:Femoral Artery / Q000000981:diagnostic imaging; D019918:Heart Valve Prosthesis Implantation / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods*; D061330:Multidetector Computed Tomography