Computed tomography as an alternative to catheter angiography prior to robotic mitral valve repair

Background: Computed tomography angiography (CTA) of the coronary arteries has been proposed as an alternative screening modality to catheter coronary angiography (CCA) prior to noncoronary cardiac surgery. The safety and utility of preoperative coronary CTA in patients undergoing robotic mitral valve repair is unknown.

Methods: One hundred and ninety consecutive patients undergoing robotic repair of degenerative mitral leaflet prolapse were eligible for preoperative CT evaluation; retrospective electrocardiogram-gated CTA of the chest to assess the coronary arteries, followed by contrast-enhanced CT of the abdomen and pelvis to assess the systemic arterial and vascular anatomy. If coronary CTA identified coronary artery stenosis 50% or greater, CCA was performed for further assessment.

Results: Computed tomography evaluation was performed in 178 patients (94%). Six patients (3%) had coronary artery stenosis 50% or greater identified on coronary CTA and underwent CCA. In each of these cases, CCA revealed no significant obstructive lesion. On a per patient basis, coronary CTA had an accuracy of 91% (95% confidence interval 0.81 to 0.96) for excluding obstructive coronary disease. The CT also demonstrated significant noncoronary vascular findings in 6 patients (3%). These findings included iliac artery dissection and aneurysm (n=4), and pulmonary embolism (n=2). Mitral repair rate was 100% and no patients underwent conversion to sternotomy. Median hospital stay was 3 days and there were no deaths.

Conclusions: In patients at low-to-intermediate risk of coronary artery disease, CT is useful as a single screening modality of the coronary arteries and peripheral vasculature to determine candidacy for minimally invasive robotic mitral valve repair.