Integrate imaging approach for minimally invasive and robotic procedures

Abstract

Over the past two decades, robotic and minimally invasive cardiac surgery has been continuously refined and is currently an alternative to traditional open-heart surgery for some patients. The parallel evolution of imaging modalities has made robotic surgery safer and more efficient. Here, we review the preand post-operative use of computed tomography (CT) in minimally invasive and robotic cardiac procedures.

Commentary: Sometimes less is more. Should minimally invasive direct coronary artery bypass become the new standard for revascularization of the left anterior descending artery?

“…Although not described here, computed tomography angiography with 3-dimensional reconstruction has been quite helpful in evaluating the conduit, localizing the distal target for bypass, and confirming the location for thoracotomy. 8 The authors also demonstrated temporal improvement in outcomes with increased surgeon experience. As expected, technical errors with anastomoses were associated with an increased incidence of major adverse cardiac events (10.8% vs 1.1%).…”

State-of-the-Art Review: Technical and Imaging Considerations in Novel Transapical and Port-Access Mitral Valve Chordal Repair for Degenerative Mitral Regurgitation

“…Although MIMVr is not solely reserved for the repair of posterior leaflet prolapse, patients with isolated P2 prolapse are particularly good candidates for MIMVr ( 13 ). Patients with or without concomitant tricuspid disease, atrial septal defect, and atrial fibrillation can be considered for a port access approach ( 13 , 14 ). However, a conventional median sternotomy is often preferred in patients who require extensive concomitant procedures such as coronary bypass graft surgery, aortic valve replacement or ascending aorta replacement ( 13 ).…”

“…Moreover, arteries with a luminal diameter < 7 mm are poor candidates for cannulation. Therefore, minimal luminal diameter, atherosclerotic burden and tortuosity or abnormal angulation of femoroiliac vessels can be determined on CT ( 14 ). By visualizing the central veins on CT, venous stenoses and occlusions, anomalies or clots can be identified that could impair venous drainage during cardiopulmonary bypass (CPB) ( 14 ).…”

“…Therefore, minimal luminal diameter, atherosclerotic burden and tortuosity or abnormal angulation of femoroiliac vessels can be determined on CT ( 14 ). By visualizing the central veins on CT, venous stenoses and occlusions, anomalies or clots can be identified that could impair venous drainage during cardiopulmonary bypass (CPB) ( 14 ). As retrograde CPB perfusion via the femoral artery may be problematic and dangerous in the presence of descending aortic aneurysm, aortic dissection, or aortic thrombus, it can add to patient-safety to check this preoperatively on CT.…”

“…The position of the right hemidiaphragm can be analyzed both on CT ( 14 ) and chest X-ray to determine the appropriate site for port placement.…”