Dillon Kate E M, Johnson Marjorie, Chan Ian L, Kiaii Bob
From 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.
Innovations (Phila). 2017 Mar/Apr;12(2):121-126. doi: 10.1097/IMI.0000000000000356.
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.
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 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.
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.
一个需要将机器人辅助内镜下单支小切口开胸手术转换为传统全胸骨切开冠状动脉搭桥手术的变量是，使用内镜摄像头无法在周围的心外膜脂肪组织中可视化左前降支冠状动脉。本研究的目的是确定术前计算机断层扫描（CT）图像检查的心外膜脂肪组织的解剖学特性是否能够预测并因此减少基于有效的术前排除标准的术中转换需求。
对转换手术组（n = 17）和成功的机器人辅助手术组（n = 17）患者的术前CT血管造影扫描进行回顾性分析。在可能的情况下，从左前降支冠状动脉最易接近的节段的轴向切片上获取心外膜脂肪组织的测量值。
结果表明，成功接受内镜下单支小切口开胸手术的患者（平均±标准差深度，4.9±1.9 mm），其血管向外侧胸壁方向的心外膜脂肪组织明显少于术中转换为全胸骨切开术的患者（平均±标准差深度，7.9±3.2 mm）。使用此作为回顾性排除标准可将该组的转换率降低47%，同时保持高特异性（94%）。两组在心外膜脂肪组织的其余测量值或体重指数方面无显著差异。
增加左前降支冠状动脉上方的心外膜脂肪组织的CT血管造影测量可能会增强该手术的术前手术规划，从而减少手术变更的情况发生。
