ArticleInterdisciplinary cardiovascular and thoracic surgery2025
Advanced imaging preparation for endoscopic mitral valve surgery - analysis of circumflex anatomy and associated procedural risks.
Article in Interdisciplinary cardiovascular and thoracic surgery, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
objectivesIatrogenic injury to the circumflex artery during mitral valve surgery occurs in 0.3-1.8% of cases. This study analyzed the circumflex artery's anatomical relationship to the mitral annulus using advanced imaging to predict peri-operative risk in patients undergoing endoscopic mitral valve surgery.
methodsA computed tomography (CT) analysis using 3mensio software was performed in 315 patients (2019-2023) undergoing minimally invasive mitral valve surgery. A prediction index for circumflex artery injury was calculated to identify at-risk individuals.
resultsCircumflex artery anatomy was assessable in all patients (n = 315). The mean age was 62.84 ± 11.34 years; median annulus area was 12.97 ± 5.69 cm2. The mean distance between the left circumflex artery and mitral annulus was 6.97 ± 3.85 mm. A critical distance < 4 mm was observed in 23.5% (74/315), among whom circumflex obstruction occurred in 2.71% (2/74), compared to 0% in those with ≥ 4 mm distance (p = 0.05). Percutaneous coronary intervention was required in 0.32% (1/315). A low injury prediction index (≤ 0.2) was found in 27.31% (86/315), correlating with male sex, larger annular dimensions, and elevated injury risk.
conclusionsPreoperative CT-based measurement of the circumflex artery's distance from the mitral annulus is feasible and may identify patients at elevated risk for iatrogenic injury. A distance ≤ 4 mm or injury prediction index ≤ 0.2 indicates increased risk. Routine CT imaging, combined with coronary angiography, is recommended for risk stratification before mitral valve surgery.
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