Advanced Imaging Preparation for Endoscopic Mitral Valve Surgery—Analysis of Circumflex Anatomy and Associated Procedural Risks

Background: Iatrogenic injuries to the circumflex artery during mitral valve surgery are severe and occur in 0.3 to 1.8%. This complication is associated with mitral valve surgery due to the close proximation to the anterolateral commissure. The aim of this study was to analyze mitral anatomy using advanced imaging software.

Methods: We performed advanced CT imaging assessment using a dedicated computer software in 313 patients from 2019 to 2023 who underwent minimally invasive mitral valve surgery in our department. Feasibility of circumflex artery assessment was evaluated and mitral annular dimensions with distance from CX were described.

Results: Mean age was 62.36 ± 11.63 years and 58.1% (182/313) patients were male. Median BMI was 26.53 ± 5.02, anulus area was 9.8 cm² ± 7.59. Median distance of RCX from mitral annulus was 5.29 mm ± 4.61. RCX distance <4 mm was present in 23.6% (74/313 patients) and <5 mm in 32.6% (102/313). CX obstruction with consecutive percutaneous coronary intervention occurred in 2/313 patients. The distance was measured between 3.6 and 3.8 mm. Rate of CX obstruction in patients with distance <4 mm was 2.7% (2/74) versus 0% (0/239) in patients with distance >4 mm (p = 0.01). 30 days mortality was 2.2% (7/313).

Conclusion: Assessment of RCX distance from mitral annulus using advanced CT imaging software is feasible in all patients prior to minimally invasive mitral valve surgery. Close location of RCX to the mitral valve with risk for injury is associated with a distance <4 mm.

No conflict of interest has been declared by the author(s).

Publication History

Article published online:
11 February 2025