title: Investigating perioperative heart migration during robot-assisted coronary artery bypass grafting interventions.
abstract: OBJECTIVE
  : For robot-assisted coronary artery bypass graft interventions, surgeons typically use a preoperative thoracic computed tomography scan of the patient to plan the procedure. However, the cardiac anatomy is prone to changes induced perioperatively in the effort to access the heart and surgical targets, which, in turn, may invalidate the initial plan. This article presents a method to estimate the perioperative heart migration, information which can be further exploited to refine the preoperative surgical plan.
  
  
  METHODS
  : Tracked transesophageal ultrasound images of four patients' hearts were acquired at each stage in the procedure: before lung deflation, after lung deflation, and after both lung deflation and CO2 thoracic insufflation. Anatomic features of interest-the mitral and aortic valves-were identified from each dataset, and their movement between the different procedure stages was recorded and used to estimate the global heart displacement. Moreover, the local morphology of the features of interest was investigated to provide insight on the extent of the deformation the heart has undergone during the workflow.
  
  
  RESULTS
  : The study suggested that the heart does undergo substantial displacement-on the order of 10 to 15 mm in each direction (axial, coronal, and sagittal) after lung deflation and CO2 thoracic insufflation. However, no significant differences (P > 0.1) were observed in the morphologic characteristics of the features of interest across the multiple workflow stages, suggesting that local deformations occur at a much smaller scale compared with the global migration.
  
  
  CONCLUSIONS
  : The quantification of the perioperatively induced changes is critical to track the displacement of the heart and surgical targets. The recorded migration patterns should not be ignored but rather be used to update the surgical plan to better suit the intraoperative environment.
authors.affiliation: Imaging Research Laboratories, Robarts Research Institute, University of Western Ontario, London, ON Canada
authors.forename: Cristian A
authors.initials: CA
authors.lastname: Linte
authors.forename: Daniel S
authors.initials: DS
authors.lastname: Cho
authors.forename: Chris
authors.initials: C
authors.lastname: Wedlake
authors.forename: John
authors.initials: J
authors.lastname: Moore
authors.forename: Elvis
authors.initials: E
authors.lastname: Chen
authors.forename: Daniel
authors.initials: D
authors.lastname: Bainbridge
authors.forename: Rajni
authors.initials: R
authors.lastname: Patel
authors.forename: Terry
authors.initials: T
authors.lastname: Peters
authors.forename: Bob B
authors.initials: BB
authors.lastname: Kiaii