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A simple method for grading aortic atherosclerosis which has prognostic value in robotic totally endoscopic coronary artery bypass
Jeffrey D. Lee, MD, Patrick G. Chan, Gregory Bittle, Patricia Y. Hong, Brody Wehman, MD, Bartley Griffith, MD, Johannes Bonatti, MD.
University of Maryland School of Medicine, Baltimore, MD, USA.
OBJECTIVE: Minimally invasive and robotic cardiac surgical procedures commonly utilize remote access peripheral perfusion. Although CT scanning has been commonly used in preoperative planning, its prognostic value has not been fully investigated.
METHODS: 244 consecutive robotic totally endoscopic coronary artery bypass (TECAB) patients who underwent preoperative contrast enhanced CT scanning of the chest, abdomen and pelvis were evaluated. Each patient was given an aortic disease grade (ADG) based on the number of atherosclerotic lesions seen. All distinct lesions measuring greater than 4 millimeters were counted starting from the subclavian artery down to the femoral arteries. Below the bifurcation of the aorta the side with the greater number of lesions was counted. The cumulative number of lesions was the ADG given to each patient and was correlated with intraoperative and postoperative clinical parameters. 169(69.3%) male and 75(30.7%) females, aged 61 + 10 years were studied. 121(49.5%) single, 104 (42.6%) double, 18 (7.3%) triple and 1(0.4%) quadruple TECAB procedures were performed using the DaVinci S and Si robotic systems.
RESULTS: Average ADG was 4.1 + 4.6. The following parameters were positively correlated with ADG; operative time (r = .201, p = 0.002), ventilation time (r = .141, p = .034), and postoperative length of stay (r = .266, p < 0.001) (Fig 1). The ADG in successfully completed TECAB patients was 3.9 + 4.6 whereas those requiring conversion to sternotomy or requiring on table graft revision was 6.3 + 5.3 (p = 0.02).
CONCLUSIONS: We conclude that preoperative CT scanning has prognostic value for robotic totally endoscopic coronary artery bypass. Although elementary in concept, the number of distinct lesions seen on CT had a direct correlation to operative time, ventilation time, need for conversion to sternotomy or on table graft revision, and postoperative length of stay. This simple method may be useful in the selection and prognostic forecasting for patients being considered for TECAB and other minimally invasive surgical procedures that use remote access peripheral perfusion. 
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