Computed Tomography in Preoperative Planning of Minimally Invasive Valvular Heart Surgery: A Systematic Review of Mixed Evidence and Clinical Application

Abstract OBJECTIVES Minimally invasive cardiac surgery (MICS) offers significant advantages over conventional sternotomy, including reduced trauma and faster recovery. Preoperative planning is crucial, with computed tomography (CT) emerging as an essential imaging tool. This systematic review aims to evaluate CT’s role in MICS planning, focusing on imaging protocols, surgical guidance, and patient outcomes. METHODS This study included studies published between January 2003 and January 2025 that examined the role of CT imaging in planning minimally invasive valvular heart surgery. A comprehensive search was conducted in MEDLINE, CINAHL, and EMBASE using predefined keywords and MeSH terms related to CT imaging, angiography, minimally invasive surgery, robotic surgery, aortic valve surgery, and mitral valve surgery. RESULTS Initial search found 378 studies, and 17 studies were included in the review. The studies highlight CT’s value in assessing surgical feasibility, vascular access, and risk stratification. CT aids in selecting arterial cannulation sites, guiding aortic occlusion strategies, and optimising port placement. It also identifies contraindications, such as extensive atherosclerosis and anatomical abnormalities that may necessitate sternotomy. CONCLUSIONS Current evidence underscores CT’s critical role in optimising MICS planning and enhancing patient safety.