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

Abstract

BACKGROUND:

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.

METHODS:

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.

RESULTS:

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.

CONCLUSION:

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.

• Authors: Gudrun Maria Feuchtner, Thomas Schachner, Nikolaos Bonaros, Alexander Smekal, Ammar Mallouhi, Guy J Friedrich, Martin Deutschmann, Guenther Laufer, Dieter zur Nedden, Johannes Bonatti
• Journal: The heart surgery forum (Heart Surg Forum) Vol. 9 Issue 5 Pg. E754-8 ( 2006) ISSN: 1522-6662 [Electronic] United States
• PMID: 16809129 (Publication Type: Journal Article)

Topics

• 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