Eligibility for minithoracotomy aortic valve replacement: from Van Praet classification to complex scanner measurements

Abstract

Van Praet proposed a classification to predict the ease of minithoracotomy aortic valve replacement (MT-AVR) based on the position of the aorta in the thorax. We have evaluated the relevance of complex computed tomography (CT) scan measurements to predict the ease of performing a MT-AVR. The first 57 patients who underwent MT-AVR from February 2018 to June 2020 were selected prior to surgery using Van Praet's IA and IB classes. We made additional measurements on aorta position related to the chest and the incision on the preoperative CT scan. The main objective was to correlate complex CT measurements with different operating durations. Van Praet criteria were significantly related to the distance from the center of the aorta to the midline (p value < 0.001), the distance from the center of the aortic ring to the midline (p value = 0.013) and aorto-sternal angle (p < 0.001). We did not find a correlation between CT criteria and the different surgical steps durations in patients belonging to Van Praet classes IA and IB. Our cohort of Van Praet class Ia and Ib patients were able to benefit from a MT-AVR without the need for conversion. Complex CT measurements do not provide additional information to predict surgical difficulties. This classification appears to be sufficient to determine a patient's eligibility for MT-AVR, even for a surgeon experienced in sternotomy in his first MT-AVR.

Consensus statement on aortic valve replacement via an anterior right minithoracotomy in the UK healthcare setting

“… 3 Additionally, the distance from the proposed ART incision to the aortic annular plane should not exceed 16 cm. 45 …”

“…Specifically, the left-right aortic location: if more than one-half of the ascending aorta is positioned to the right of a vertical line drawn from the right sternal border to the ascending aorta in the axial CT view, ART is appropriate 3. Additionally, the distance from the proposed ART incision to the aortic annular plane should not exceed 16 cm 45…”

Advances in TEE-Centric Intraprocedural Multimodal Image Guidance for Congenital and Structural Heart Disease

“…This article assessed the significance of intricate computed tomography scan measurements in anticipating MT-AVR procedures’ feasibility. [ 16 ] 2022 CMR This review delved into the physics underlying black-blood contrast and diverse strategies for achieving blood suppression. It also explained the technical complexities of black-blood contrast, how it is influenced by flow and motion conditions, its additional contrast weighting mechanisms (T1, T2, etc.…”

“…The diagnosis of SHD usually requires a variety of imaging tests, including electrocardiography [ 6 ], echocardiography [ 7 ], computed tomography (CT) [ 8 ], magnetic resonance imaging (MRI) [ 8 , 9 ], and invasive cardiac catheterization [ 10 , 11 ]. After diagnosis, SHD is increasingly treated via minimally invasive interventional procedures [ 12 ]—e.g., cardiac catheter occlusion or a closure of defects [ 13 ], valve replacement or repair, etc.—under imaging guidance [ 14 , 15 , 16 , 17 ]. In a well-planned and executed cardiac catheterization procedure, imaging is fundamental for all aspects of the transcatheter treatment process, including pre-procedural planning, the assessment of the extent of the disease, diagnosing and detecting risk factors, and intraoperative guidance, as shown in Figure 1 .…”