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


CONCLUSIONS
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.
Feuchtner
Gudrun Maria
GM
Department of Radiology II, Innsbruck Medical University, Innsbruck, Austria. Gudrun.Feuchtner@uibk.ac.at
Schachner
Thomas
T
Bonaros
Nikolaos
N
Smekal
Alexander
A
Mallouhi
Ammar
A
Friedrich
Guy J
GJ
Deutschmann
Martin
M
Laufer
Guenther
G
zur Nedden
Dieter
D
Bonatti
Johannes
J
D001011:Aorta; D001018:Aortic Diseases / Q000000981:diagnostic imaging*; D050197:Atherosclerosis / Q000000981:diagnostic imaging*; D001026:Coronary Artery Bypass / Q000379:methods*; D004724:Endoscopy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011300:Preoperative Care; D012371:Robotics; D014057:Tomography, X-Ray Computed