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.
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.
Achenbach S, Moselewski F, Ropers D, et al. 2004. Detection of calcified and noncalcified coronary atherosclerotic plaque by contrast-enhanced, submillimeter multidetector spiral computed tomography: a segment-based comparison with intravascular ultrasound. Circulation 109:14-7.nAmarenco P, Cohen A, Tzourio C, et al. 1994. Atherosclerotic disease of the aortic arch and the risk of ischemic stroke. N Engl J Med 331:1474-9.nCatalano C, Fraioli F, Laghi A. 2004. Infrarenal aortic and lower-extremity arterial disease: diagnostic performance of multi-detector row CT angiography. Radiology 231:555-63.nde Korte CL, Pasterkamp G, van der Steen AF, et al. 2000. Characterization of plaque components with intravascular ultrasound elastography in human femoral and coronary arteries in vitro. Circulation 102:617-23.nFlohr T, Bruder H, Stierstorfer K, et al. 2002. New technical developments in multislice CT, part 2. Sub-millimeter 16-slice scanning and increased gantry rotation speed for cardiac imaging. Rofo Fortschr Geb Roentgenstr 174:1023-7.nHerzog C, Dogan S, Diebold T, et al. 2003. Multi-detector row CT versus coronary angiography: preoperative evaluation before totally endoscopic coronary artery bypass grafting. Radiology 229:200-8.nHoffmann U, Moselewski F, Cury RC, et al. 2004. Predictive value of 16-slice multidetector spiral computed tomography to detect significant obstructive coronary artery disease in patients at high risk for coronary artery disease: patient-versus segment-based analysis. Circulation 110:2638-43.nHoffmann M, Shi H, Schmitz B, et al. 2005. Non-invasive coronary angiography with multislice computed tomography. JAMA 293:2471-8.nKuettner A, Kopp A, Schroeder S, et al. 2004. Diagnostic accuracy of multidetector computed angiography in patients with angiographically proven coronary artery disease. J Am Coll Cardiol 43:831-9.nLeber AW, Knez A, Becker A, et al. 2004. Accuracy of multidetector spiral computed tomography in identifying and differentiating the composition of coronary atherosclerotic plaques: a comparative study with intracoronary ultrasound. J Am Coll Cardiol 43:1241-7.nLee RT, Richardson SG, Loree HM, et al. 1992. Prediction of mechanical forces of human atherosclerotic plaque by high-frequency intravascular ultrasound imaging. A vitro study. Arterioscler Thromb 12:1-5.nMollet NR, Cademartiri F, Krestin GP, et al. 2005. Improved diagnostic accuracy with 16-row multi-slice computed tomography coronary angiography. J Am Coll Cardiol 45:128-32.nMollet NR, Cademartiri F, Nieman K, et al. 2005. Noninvasive assessment of coronary plaque burden using multislice computed tomography. Am J Cardiol 95:1165-9.nNieman K, Pattynama PMT, Rensing BJ, et al. 2003. Evaluation of patients after coronary artery bypass surgery: angiographic assessment of grafts and coronary arteries. Radiology 229:749-56.nRoos JE, Willmann JK, Weishaupt D, et al. 2002. Thoracic aorta: motion artifact reduction with retrospective and prospective electrocar-diography-assisted multi-detector row CT. Radiology 222:271-7.nSchachner T, Bonaros N, Laufer G, et al. 2004. The ESTECH remote access perfusion cannula in minimally invasive cardiac surgery. Heart Surg Forum 7:E632-5.nSchachner T, Nagele G, Kacani A, Laufer G, Bonatti J. 2004. Factors associated with presence of ascending aortic atherosclerosis in CABG patients. Ann Thorac Surg 78:2028-32.nSchlosser T, Konorza T, Hunold P, et al. 2004. Noninvasive visualization of coronary artery bypass grafts using 16-detector row computed tomography. J Am Coll Cardiol 44:1224-9.nSoler R, Rodriguez E, Requejo I, et al. 1998. Magnetic resonance imaging of congenital abnormalities of the thoracic aorta. Eur Radiol 8:540-6.n
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