Utility of spiral CT in minimally invasive approach for aortic valve replacement

OBJECTIVE: Several surgical approaches exist for a minimally invasive replacement of the aortic valve. A great concern exists about the variable exposure of the aortic root. We suggest the use of spiral CT as a non-invasive method for accurate determination of aortic annulus position. METHODS: Three patients scheduled for minimally invasive aortic valve replacement underwent chest spiral CT, (Select SP, Elscint, Haifa, Israel). Scanning was performed during breath holding using 5-mm thick slices, reconstructed every 2 mm (3 mm overlap), and a 1.5 pitch. Average scanning time was 30 s. No intravenous contrast media was used. Multiplannar and 3D images were reconstructed, using an Omnipro work station (Elscint LTD, Haifa, Israel). The position of the aortic valve annulus, in relation to the anterior chest wall was defined on these images. RESULTS: In all patients, the length and location of the incision were determined by the preoperative measurements. The location of the aortic valve was found highly correlative to the preliminary study. There was no need to extend the length of the incision, or change the surgical approach. CONCLUSIONS: We find spiral CT scanning enables accurate pre-operative anatomical assessment. This assessment, provides the surgeon with the advantage of preliminary planning of the appropriate approach for minimally invasive aortic valve replacement.