Multidetector CT Scan Facilitates Complex Totally Endoscopic Coronary Artery Bypass Grafting (TECAB)

(#2001-6847 ... June 27, 2001)

Selami Dogan, ¹ Gerhard Wimmer-Greinecker, ¹ Tayfun Aybek, ¹ Omer Dzemali, ¹ Christopher Herzog, ² Thomas J Vogl, ² Anton Moritz¹

¹Department of Thoracic and Cardiovascular Surgery
²Department of Diagnostic and Interventional Radiology
Johann Wolfgang Goethe-University Frankfurt, Germany

Presented at the Fourth Annual Scientific Meeting of the International Society for Minimally Invasive Cardiac Surgery, June 27-30, 2001, Munich, Germany.

ABSTRACT

Background: In closed chest coronary artery bypass grafting using robotically enhanced telemanipulation the identification and exposition of the coronary artery target vessel may be difficult due to various reasons. With coronary angiography and other conventional imaging techniques only the vessel lumen can be visualized. Intramural position, occluded vessel segments and vessel wall quality are not visualized preoperatively for optimal targeting during a closed chest procedure.

Methods: We used high resolution multidetector CT (MDCT) scan to obtain 2- and 3-dimensionally reconstructed images of the heart in patients with single vessel coronary artery disease scheduled for totally endoscopic coronary artery bypass grafting and correlated pre and intraoperative findings. Three different reconstruction algoritm and ECG gating were used to obtain 3 D images of the heart and coronary arteries.

Results: Between March 2000 and May 2001, 25 patients underwent preoperative MDCT. The location of the LAD was predicted to be epicardial in 20 out of 20 patients (100 %). In 5 cases an intramyocardial course of the LAD was predicted, which was confirmed in 4 cases ( 80 %). Mean target vessel diameter was determined to be 1.6 ± 0.3 mm. In 6 patients the occluded LAD was visualized by MDCT. All these occluded vessels turned out to be graftable. In 1 patient the target site had soft plaques, which were predicted correctly.

Conclusion: With MDCT scan valuable information such as epi or myocardial position, coronary vessel diameter and wall quality can be obtained preoperatively in a non invasive fashion facilitating planning of complex procedures like totally endoscopic coronary artery bypass grafting (TECAB). Patients with severe calcification of the LAD can be identified to decide on the optimal surgical technique.