Stoliński Jarosław, Plicner Dariusz, Grudzień Grzegorz, Kruszec Paweł, Fijorek Kamil, Musiał Robert, Andres Janusz
Department of Cardiovascular Surgery and Transplantology, Jagiellonian University in Cracow, John Paul II Hospital, Cracow, Poland.
Department of Cardiovascular Surgery and Transplantology, Jagiellonian University in Cracow, John Paul II Hospital, Cracow, Poland.
Ann Thorac Surg. 2016 May;101(5):1745-52. doi: 10.1016/j.athoracsur.2015.10.076. Epub 2016 Jan 12.
This study evaluated the role of multidetector computed tomography (MDCT) in preparation for minimally invasive aortic valve replacement (MIAVR).
An analysis of 187 patients scheduled for MIAVR between June 2009 and December 2014 was conducted. In the study group (n = 86), MDCT of the thorax, aorta, and femoral arteries was performed before the operation. In the control group (n = 101), patients qualified for MIAVR without receiving preoperative MDCT.
The surgical strategy was changed preoperatively in 12.8% of patients from the study group and in 2.0% of patients from the control group (p = 0.010) and intraoperatively in 9.9% of patients from the control group and in none from the study group (p = 0.002). No conversion to median sternotomy was necessary in the study group; among the controls, there were 4.0% conversions. On the basis of the MDCT measurements, optimal access to the aortic valve was achieved when the angle between the aortic valve plane and the line to the second intercostal space was 91.9 ± 10.0 degrees and to the third intercostal space was 94.0 ± 1.4 degrees, with the distance to the valve being 94.8 ± 13.8 mm and 84.5 ± 9.9 mm for the second and third intercostal spaces, respectively. The right atrium covering the site of the aortotomy was present in 42.9% of cases when MIAVR had been performed through the third intercostal space and in 1.3% when through the second intercostal space (p = 0.001).
Preoperative MDCT of the thorax, aorta, and femoral arteries makes it possible to plan MIAVR operations.
本研究评估了多排螺旋计算机断层扫描（MDCT）在微创主动脉瓣置换术（MIAVR）术前准备中的作用。
对2009年6月至2014年12月期间计划进行MIAVR的187例患者进行分析。研究组（n = 86）在手术前进行胸部、主动脉和股动脉的MDCT检查。对照组（n = 101）为符合MIAVR条件但未接受术前MDCT检查的患者。
研究组12.8%的患者术前手术策略发生改变，对照组为2.0%（p = 0.010）；对照组9.9%的患者术中手术策略发生改变，研究组无患者发生改变（p = 0.002）。研究组无需转为正中开胸；对照组中有4.0%转为正中开胸。根据MDCT测量结果，当主动脉瓣平面与第二肋间空间连线的夹角为91.9±10.0度、与第三肋间空间连线的夹角为94.0±1.4度时，可实现对主动脉瓣的最佳入路，第二和第三肋间空间到瓣膜的距离分别为94.8±13.8 mm和84.5±9.9 mm。通过第三肋间空间进行MIAVR时，42.9%的病例存在右心房覆盖主动脉切口部位的情况，通过第二肋间空间进行手术时这一比例为1.3%（p = 0.001）。
术前对胸部、主动脉和股动脉进行MDCT检查有助于规划MIAVR手术。
