Evaluation of ascending aortic atherosclerosis with 16-multidetector computed tomography is useful before total endoscopic coronary bypass surgery

• Published in: The Heart surgery forum Vol. 9; no. 5; p. E754
• Main Authors: Feuchtner, Gudrun Maria, Schachner, Thomas, Bonaros, Nikolaos, Smekal, Alexander, Mallouhi, Ammar, Friedrich, Guy J, Deutschmann, Martin, Laufer, Guenther, zur Nedden, Dieter, Bonatti, Johannes
• Format: Journal Article
• Language: English
• Published: United States 2006
• Subjects: Aorta; Aortic Diseases - diagnostic imaging; Atherosclerosis - diagnostic imaging; Coronary Artery Bypass - methods; Endoscopy; Female; Humans; Male; Middle Aged; Preoperative Care; Robotics; Tomography, X-Ray Computed
• ISSN: 1522-6662
• DOI: 10.1532/HSF98.20051103

The purpose of this study was to investigate the assessment of ascending aortic atherosclerosis with 16-multidetector computed tomography (16-MDCT) angiography prior to total endoscopic coronary artery bypass (TECAB) surgery. Forty-five patients were examined with electrocardiogram-gated, 16-MDCT angiography. The presence of atherosclerosis at the ascending aorta was graduated as severe (>50% of circumference) or as mild (<50% of circumference). Ascending aortic plaque composition was evaluated based on CT densities expressed as Hounsfield units (HU). TECABs using the Da Vinci telemanipulator were performed either on the arrested heart (n = 39) with an intra-aortic cardiopulmonary bypass (CPB) perfusion device or on the beating heart (n = 6) in patients with severe atherosclerosis. The presence of mild atherosclerosis at the ascending aorta (11/39) was associated with intra-aortic CPB perfusion device-related difficulties such as intra-aortic balloon migration (BM) or balloon rupture (P = .007) in arrested heart TECABs. The CT density of atherosclerotic plaque in patients with BM was mean 58 HU +/- 51 standard deviation (SD), suggesting noncalcifying plaque. In patients without BM, CT density of plaque was mean 526 HU +/- 306 SD corresponding to calcifying plaque (P < .001). Balloon rupture occurred in 2 patients who had calcifying plaque at the ascending aorta. Evaluation of ascending aortic atherosclerosis with 16-MDCT angiography is useful prior to TECAB surgery. Even mild atherosclerosis of the ascending aorta is associated with intraoperative difficulties regarding the remote-access perfusion system that is used for arrested heart TECAB surgery.