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Pre‐operative Eligibility for Minimally Invasive Coronary Artery Bypass Grafting Using the DaVinci Robot: An Examination of Anatomical Parameters using Computed Tomography

Minimally invasive coronary artery bypass procedures have been shown to reduce morbidity, 30‐day complication rates, and length of hospital stays, as well as increasing patient quality of life scores post‐operatively. The robotic‐assisted endoscopic single‐vessel small thoracotomy (endo‐SVST) bypass procedure is a minimally invasive procedure that confers similar benefits to the more invasive conventional full‐sternotomy revascularization approach. A limitation to the endo‐SVST procedure that still requires attention is the pre‐operative selection criteria. Inappropriate selection can result in intra‐operative conversions from the endo‐SVST to a conventional full‐sternotomy resulting in increased patient morbidity, and both operative and general anesthetic times along with increased costs. One of the primary intraoperative concerns, necessitating conversion to a conventional full‐sternotomy, is the inability of the endoscopic camera to visualize the left anterior descending (LAD) coronary artery, the target vessel, under the surrounding epicardial adipose tissue. The purpose of this study is to determine if anatomical and anthropometric parameters, examined using both patient data and pre‐operative computed tomography (CT) images, are able to predict and thus reduce the need for conversion based on effective pre‐operative exclusion criteria.