Abstract 14595: Radiographic Predictors of Operative Difficulty in Minimally Invasive Mitral Valve Surgery
OBJECTIVE Selection of candidates for minimally invasive cardiac surgery (MICS) is largely dictated by individual surgeon preference, and based on subjective assessments of body size and shape. Poor patient selection for minimally invasive cases can result in increased morbidity and mortality associated with longer bypass times and conversion from minimally invasive approach to median sternotomy. We sought to use measurements from readily available chest radiographs (CXR) to predict the difficulty with minimally invasive exposure and to determine anatomic eligibility for such approaches.
METHODS From 2006-2009, 294 patients underwent MICS at our institution. To study a standardized population, 100 consecutive patients were selected who had isolated first-time mitral valve repair or planned mitral valve replacement via right minithoracotomy. A preoperative CXR was analyzed by a single radiologist blinded to all clinical data. Primary outcomes were cardiopulmonary bypass (CPB) and aortic cross clamp (XC) times, surrogates of operative difficulty.
RESULTS The average age of the study group was 55 ± 14 years. Increased transverse chest width, decreased distance from the left chest wall to the left side of the heart, and decreased width of the fourth intercostal space were associated with increased intraoperative times (table). Threshold values for increased operative difficulty appeared to be chest width greater than 34cm and intercostal width less than 1.4cm. BMI was not correlated with either CPB or XC times.
CONCLUSIONS Measurements taken from preoperative chest radiographs, which are available in nearly all patients, may be valuable in assessing anatomic relationships relevant to the prediction of operative difficulty in MICS. It may be possible to use these measures to create a scoring scale that can guide surgeons considering the advisability of MICS approaches, especially in borderline cases.
- © 2011 by American Heart Association, Inc.