Off-Pump Coronary Artery Bypass Grafts Assessment by Multislice Computed Tomography
DOI:
https://doi.org/10.1532/hsf.1093Abstract
Background: Selective coronary angiography is the standard but invasive procedure for postoperative assessment of coronary artery bypass graft patency. The aim of this prospective study is to evaluate the multislice computed tomography (CT) as a means of postoperative patency assessment and anastomotic site control of arterial and venous coronary bypass grafts performed with off-pump coronary artery bypass techniques.
Methods: Over a 6-month period, 20 patients underwent isolated coronary artery bypass (beating heart technique) and benefited, 7 days later, from a patency and anastomotic site control by multidetector angio multislice CT with cardiac gating.
Results: Whole internal thoracic artery bypasses and venous grafts were visualized perfectly on their entire length, including the anastomotic site, and 3-dimensional reconstruction was possible. The relationship between cardiac cavities and the bypasses were well visualized, allowing quantification of bypass stenosis ensured by software analysis.
Conclusions: Postoperative control of coronary bypasses is possible by multislice CT with a very satisfactory resolution, thus making it possible to check the patency of coronary bypasses and the quality of anastomosis with a noninvasive method. Three-dimensional reconstructions are very useful in the event of redo surgery.
References
Achenbach S, Moshage W, Bachmann K. 1996. Coronary angiography by electron beam tomography. Herz 21:106-11.nAchenbach S, Moshage W, Ropers D, et al. 1997. Noninvasive, three-dimensional visualization of coronary artery bypass grafts by electron beam tomography. Am J Cardiol 79:856-61.nAlbrechtsson U, Stahl E, Tylen U. 1981. Evaluation of coronary artery bypass graft patency with computed tomography. J Comput Assist Tomogr 5:822-6.nBateman TM, Gray RJ, Whiting JS, Matloff JM, Berman DS, Forrester JS. 1986. Cine computed tomographic evaluation of aortocoronary bypass graft patency. J Am Coll Cardiol 8:693-8.nBenetti FJ, Naselli G, Wood M, Geffner L. 1991. Direct myocardial revascularization without extracorporeal circulation. Experience in 700 patients. Chest 100:312-6.nChristiaens L, Mankoubi L, Coisne D, et al. 1998. Coronarographie chez l'octogénaire, impact thérapeutique et suivi à moyen terme. Arch Mal Cœur 91:1125-31.nDaniel WG, Dohring W, Lichtlen PR, Stender HS. 1980. Non-invasive assessment of aortocoronary bypass graft patency by computed tomography. Lancet 1(8176):1023-4.nDemaria R, Vernhet H, Battistella P, et al. 2003. Contrôle postopératoire de la perméabilité des pontages coronaires par angioscanner spiralé multibarette : Etude préliminaire de faisabilité. J Chir Thorac Cardio-Vasc. In press.nEngelmann MG, von Smekal A, Knez A. 1997. Accuracy of spiral computed tomography for identifying arterial and venous coronary graft patency. Am J Cardiol 80:569-74.nGundry SR, Romano MA, Shattuck OH, Razzouk AJ, Bailey LL. 1998. Seven-year follow-up of coronary artery bypasses performed with and without cardiopulmonary bypass. J Thorac Cardiovasc Surg 115:1273-7.nHaaverstad R, Vitale N, Tjomsland O, Tromsdal A, Torp H, Samstad SO. 2002. Intraoperative color Doppler ultrasound assesment of LIMA-to-LAD anastomoses in off-pump coronary artery bypass grafting. Ann Thorac Surg 74:S1390-4.nJara FM, Kalush J, Kahn ML. 2002. Electron beam coronary angiography to assess patency in the off-pump coronary bypass graft. Ann Thorac Surg 74:S1395-7.nNieman K, Oudkerk M, Rensing BJ, et al. 2001. Coronary angiography with multi-slice computed tomography. Lancet 357(9256):599-603.nNieman K, Cademartiri F, Lemos PA, Raaijmakers R, Pattynama PMT, de Feyter PJ. 2002. Reliable noninvasive coronary angiography with fast submillimeter multislice spiral computed tomography. Circulation 106:2051-4.nPfister AJ. 1997. The safety of CABG without cardiopulmonary bypass. Ann Thorac Surg 64:590-1.nTreede H, Becker C, Reichenspurner H, et al. 2002. Multidetector computed tomography (MDCT) in coronary surgery: first experiences with a new tool for diagnosis of coronary artery disease. Ann Thorac Surg 74:S1398-402.n
