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Published on: August 28, 2018
Eligibility for Minimally Invasive Coronary Artery Bypass: Examination of Epicardial Adipose Tissue Using Computed
Kate E M Dillon1, Marjorie Johnson, Ian L Chan
1From the *Department of Anatomy and Cell Biology, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada; and †Department of Radiology, and ‡Division of Cardiac Surgery, London Health Sciences Centre, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.
Insights
Preoperative CT scans can predict the need for conversion during robotic-assisted bypass surgery by measuring epicardial adipose tissue depth. This reduces conversion rates by 47% and improves surgical planning for coronary artery bypass grafting.
Area of Science:
- Cardiovascular Surgery
- Medical Imaging
- Thoracic Surgery
Background:
- Robotic-assisted endoscopic coronary artery bypass grafting offers minimally invasive benefits.
- Intraoperative conversion to sternotomy is often necessitated by poor visualization of the left anterior descending artery due to epicardial adipose tissue.
- Effective preoperative criteria are needed to minimize these conversions.
Purpose of the Study:
- To evaluate if preoperative computed tomography (CT) imaging of epicardial adipose tissue can predict and reduce intraoperative conversions.
- To establish exclusion criteria based on anatomical properties visible in CT scans.
Main Methods:
- Retrospective analysis of CT angiography scans from 17 converted and 17 successful robotic-assisted procedures.
- Measurement of epicardial adipose tissue depth overlying the left anterior descending coronary artery in axial CT slices.
Main Results:
- Significantly less epicardial adipose tissue depth was observed in successful robotic-assisted cases (4.9 ± 1.9 mm) compared to converted cases (7.9 ± 3.2 mm).
- Utilizing adipose tissue depth as a retrospective exclusion criterion reduced conversion rates by 47% with 94% specificity.
- No significant differences in other adipose tissue measurements or body mass index were found between groups.
Conclusions:
- Preoperative CT angiography measurements of epicardial adipose tissue can enhance surgical planning for robotic-assisted bypass.
- This approach may significantly reduce the incidence of intraoperative procedural changes, optimizing patient outcomes.
Objective:
A variable that necessitates conversion to a conventional full-sternotomy coronary artery bypass procedure from a robotic-assisted endoscopic single-vessel small thoracotomy is the inability to visualize the left anterior descending coronary artery within the surrounding epicardial adipose tissue using the endoscopic camera. The purpose of this study was to determine whether anatomical properties of the epicardial adipose tissue examined using preoperative computed tomography (CT) images are able to predict and thus reduce the need for intraoperative conversion based on effective preoperative exclusion criteria.
Methods:
Retrospective analysis of patient preoperative CT angiography scans from both converted (n = 17) and successful robotic-assisted (n = 17) procedures was performed. Where possible, measurements of epicardial adipose tissue were acquired from axial slices, at the most accessible segment of the left anterior descending coronary artery.
Results:
Results indicate that patients who successfully underwent the endoscopic single-vessel small thoracotomy procedure (mean ± SD depth, 4.9 ± 1.9 mm) had significantly less epicardial adipose tissue (38%, P = 0.002) overlying the vessel toward the lateral chest wall than those who were converted to the full-sternotomy approach intraoperatively (mean ± SD depth, 7.9 ± 3.2 mm). Using this as a retrospective exclusion criterion reduces the conversion rate for this group by 47%, while maintaining a high specificity (94%). No significant differences exist between the two groups with respect to the remaining epicardial adipose tissue measurements or body mass index.
Conclusions:
The addition of CT angiography measurements of the epicardial adipose tissue overlying the left anterior descending coronary artery may enhance preoperative surgical planning for this procedure, thereby reducing the instances of procedural changes.
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