Evaluation of Ascending Aortic Atherosclerosis with 16-Multidetector Computed Tomography Is Useful before Total Endoscopic Coronary Bypass Surgery


  • Gudrun Maria Feuchtner
  • Thomas Schachner
  • Nikolaos Bonaros
  • Alexander Smekal
  • Ammar Mallouhi
  • Guy J. Friedrich
  • Martin Deutschmann
  • Guenther Laufer
  • Dieter zur Nedden
  • Johannes Bonatti




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.


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How to Cite

Feuchtner, G. M., Schachner, T., Bonaros, N., Smekal, A., Mallouhi, A., Friedrich, G. J., Deutschmann, M., Laufer, G., Nedden, D. zur, & Bonatti, J. (2006). Evaluation of Ascending Aortic Atherosclerosis with 16-Multidetector Computed Tomography Is Useful before Total Endoscopic Coronary Bypass Surgery. The Heart Surgery Forum, 9(5), E754-E758. https://doi.org/10.1532/HSF98.20051103