Abstract
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 β-coefficient 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.
Publisher
Springer Science and Business Media LLC
Subject
Cardiology and Cardiovascular Medicine,General Medicine,Surgery,Pulmonary and Respiratory Medicine
Reference32 articles.
1. Bustamante J, Canovas S, Fernández ÁL. Minimally Invasive Aortic Valve Surgery - New Solutions to Old Problems. In: Aortic Stenosis - Etiology, Pathophysiology and Treatment: InTech; 2011.
http://www.intechopen.com/books/aortic-stenosis-etiology-pathophysiology-and-treatment/minimally-invasive-aortic-valve-surgery-new-solutions-to-old-problems
.
2. Gilmanov D, et al. Minimally invasive aortic valve replacement: 12-year single center experience. Ann Cardiothorac Surg. 2015;4(2):160–9.
3. Castrovinci S, et al. Minimally invasive aortic valve surgery. J Geriatr Cardiol. 2016;13(6):499–503.
4. Akowuah E, et al. Manubrium-limited ministernotomy versus conventional sternotomy for aortic valve replacement (MAVRIC): study protocol for a randomised controlled trial. Trials. 2017;18(1):46.
5. Nair SK, et al. Mini-Stern Trial: A randomized trial comparing mini-sternotomy to full median sternotomy for aortic valve replacement. J Thorac Cardiovasc Surg. 2018;156(6):2124–2132.e31.
Cited by
6 articles.
订阅此论文施引文献
订阅此论文施引文献,注册后可以免费订阅5篇论文的施引文献,订阅后可以查看论文全部施引文献