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Anatomic Measurements in Preoperative CT Scans Predict Operative Times in Robotic Totally Endoscopic Coronary Artery Bypass Surgery
Brody Wehman, Kian Lahiji, Jeffrey D. Lee, Zachary N. Kon, Patricia Hong, Marc Gibber, Eric J. Lehr, Jean Jeudy, Bartley P. Griffith, Johannes Bonatti.
University of Maryland School of Medicine, Baltimore, MD, USA.
Objective: Endoscopic procedures require accurate preoperative planning. Computed tomography (CT) provides anatomic information which can support this planning process. The aim of the study was to determine if patient anatomy as determined by preoperative CT scan correlates with intra-operative time requirements for different procedural steps and overall operative time in robotic total endoscopic coronary artery bypass (TECAB).
Methods: Preoperative CT scans were retrospectively reviewed for 108 consecutive patients who underwent single vessel TECAB from 8/2008 to 8/2011. Anatomic measurements included dimensions of the heart and chest cavity, angle of cardiac rotation, left internal mammary artery (LIMA) to left anterior descending (LAD) distance, depth of thoracic subcutaneous tissue, distance from left heart border to chest wall, and thickness of pericardial fat. Findings were correlated with time to complete various intra-operative procedural steps as well as overall operative time.
Results: Of 108 procedures there were 63 performed on the arrested heart (AH) and 45 on the beating heart (BH). There was a significant correlation between LIMA harvest time and depth of subcutaneous tissue at the level of the nipple (r = 0.24,0 p= 0.018). Pericardial fat pad thickness was associated with longer resection times (r = 0.266, p = 0.008). LIMA to LAD anastomotic time was inversely correlated with distance from left heart border to chest wall (r = -0.241, p = 0.016). Total operative time was also inversely correlated to this distance (r = -0.275, p = 0.005) (Figure 1). 
Conclusions: Preoperative CT measurements in patients undergoing robotic totally endoscopic coronary artery bypass grafting can predict time requirements for various procedural steps. Patients with greater amounts of subcutaneous tissue require longer LIMA harvesting times. A large pericardial fat pad requires more time for removal. Short distance between the chest wall and the heart predicts longer LIMA to LAD anastomotic times and total operative times.
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