Preoperative multidetector computed tomograpy angiography for planning of minimally invasive robotic mitral valve surgery: Impact on decision making

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.