Evaluation of Myocardial Flow Reserve Using Pharmacological Stress Thallium-201 Single-Photon Emission Computed Tomography: Is There a Difference between Total Arterial Off-Pump Coronary Artery Bypass Grafting and Conventional Coronary Artery Bypass
Background: The advantage of total arterial off-pump coronary bypass grafting (OPCAB) over conventional on-pump coronary artery bypass grafting with 1 internal thoracic artery and veins (CCAB) in terms of myocardial flow reserve has not been studied. We studied these procedures using thallium-201 perfusion single-photon emission computed tomography (Tl-201 perfusion SPECT).
Methods: Between 1997 and 2001, 152 patients were recruited from our database (OPCAB, n = 100; CCAB, n = 52). All patients underwent pharmacological stress Tl-201 perfusion SPECT 3 to 12 months after bypass surgery. Myocardial perfusion was analyzed semiquantitatively with a 5-point scoring system in a 20-segment model (0, normal, to 4, absence of uptake). Summed stress (SSS), rest (SRS), and difference score (SDS) of the entire myocardium as well as average scores (ASS, ARS, ADS) of individual walls (anterior, septal, lateral, and inferior) were compared by Student t test as well as by repeated-measures analysis of variance with Bonferroni correction.
Results: The SSS, SRS, and SDS of OPCAB versus those of CCAB were 6.86 ± 0.72 versus 7.17 ± 0.92, 3.95 ± 0.57 versus 3.75 ± 0.73, and 2.91 ± 0.47 versus 3.42 ± 0.74 (P > .05). However, the lateral wall showed lower scores in OPCAB (ASS, 0.18 versus 0.41, P = .015; ARS, 0.12 versus 0.20, P = .168; ADS, 0.06 versus 0.21, P = .031). The septal wall had higher scores in OPCAB (ASS, 0.33 versus 0.12, P = .003; ARS, 0.18 versus 0.07, P = .037; ADS, 0.14 versus 0.04, P = .030). The anterior and inferior walls were not different between the 2 groups.
Conclusions: OPCAB led to results similar to those of CCAB. The better results in the lateral wall have been the effect of grafting radial artery rather than vein. The similarity in myocardial reserve in the inferior wall between the 2 groups needs further study. There was no deleterious effect of off-pump as opposed to on-pump CAB.
Taki J, Ichikawa A, Nakajima K, Kawasuji M, Tonami M. 1997. Comparison of flow capacities of arterial and venous grafts for coronary artery bypass grafting: evaluation with exercise thallium-201 single-photon emission tomography. Eur J Nucl Med 24:1487-93.nWebster MW, Scott RS. 1997. What cardiologists need to know about diabetes. Lancet 350:S123-8.nZellweger MJ, Lewin HC, Lai S, et al. 2001. When to stress patients after coronary artery bypass surgery? risk stratification in patients early and late post-CABG using stress myocardial perfusion SPECT: implications of appropriate clinical strategies. J Am Coll Cardiol 37:144-52.nIshino Y, Nakata H. 2000. Coronary flow reserve evaluated by 201 Tl myocardial perfusion SPECT after coronary artery bypass grafting (CABG) for angina pectoris. Kaku Igaku 37:621-9.nJegaden O, Bontemps L, de Gevigney G, et al. 1998. Does the extended use of arterial grafts compromise the myocardial recovery after coronary artery bypass grafting in left ventricular dysfunction? Eur J Cardiothorac Surg 14:353-9.nJegaden O, Bontemps L, de Gevigney G, et al. 1999. Two-year assessment by exercise thallium scintigraphy of myocardial revascularization using bilateral internal mammary and gastroepiploic arteries. Eur J Cardiothorac Surg 16:131-4.nKhoury AF, Rivera JM, Mahmarian JJ, Verani MS. 1997. Adenosine thallium-201 tomography in evaluation of graft patency late after coronary artery bypass graft surgery. J Am Coll Cardiol 29:1290-5.nKim KB, Cho KW, Chang WI, et al. 2002. Bilateral skeletonized internal thoracic artery grafting in off-pump coronary artery bypass: early result of Y versus in situ grafts. Ann Thorac Surg 74:S1371-6.nLev-Ran O, Mohr R, Uretzky G, et al. 2003. Graft of choice to right coronary system in left sided bilateral internal thoracic artery grafting. Ann Thorac Surg 75:88-92.nLytle BW, Blackstone EH, Loop FD, et al. 1999. Two internal thoracic artery grafts are better than one. J Thorac Cardiovasc Surg 117:855-72.nLytle BW, Cosgrove DM. 1992. Coronary artery bypass surgery. Curr Probl Surg 29:733-807.nManiar HS, Barner HB, Bailey MS, et al. 2003. Radial artery patency: are aortocoronary conduits superior to composite grafting? Ann Thorac Surg 76:1498-504.nMehta J, Hamby RI, Aintablian A, et al. 1975. Preoperative coronary angiographic follow-up of sequential internal thoracic artery grafting. Eur J Cardiothoracic Surg 17:407-14.nPuskas JD, Wright CE, Ronson RS, et al. 1999. Clinical outcomes and angiographic patency in 125 consecutive off-pump coronary bypass patients. Heart Surg Forum 2:216-21.nShennib H, Endo M, Benhamed O, Morin JF. 2002. Surgical revascularization in patients with poor left ventricular function: on- or off-pump? Ann Thorac Surg 74:1344-7.nAkasaka T, Yoshikawa J, Yoshida K, et al. 1995. Flow capacity of internal mammary artery grafts: early restriction and later improvement assessed by Doppler guide wire: comparison with saphenous grafts. J Am Coll Cardiol 25:640-7.nBerman DS, Hachamovitch R, Kiat H, et al. 1995. Incremental value of prognostic testing in patients with known or suspected ischemic heart disease: a basis for optimal utilization of exercise technetium-99m sestamibi myocardial perfusion single-photon emission computed tomography. J Am Coll Cardiol 26:139-47.nBittner HB, Savitt MA. 2002. Off-pump coronary artery bypass grafting decreases morbidity and mortality in a selected group of high-risk patients. Ann Thorac Surg 74:115-8.nCameron A, Davis KB, Green GE, Myers WO, Pettinger M. 1988. Clinical implications of internal mammary artery bypass grafts: the Coronary Artery Surgery Study experience. Circulation 77:815-9.nEagle KA, Guyton RA, Daridoff R, et al. 1999. ACC/AHA guidelines for coronary artery bypass graft surgery: executive summary and recommendations: a report of the American College of Cardiology/American HeartnAssociation Task Force on Practice Guidelines (Committee to revise the 1991 guidelines for coronary artery bypass graft surgery). Circulation 100:1464-80.nHirose H, Amano A, Takahashi A, et al. 2001. Off-pump coronary artery bypass grafting for elderly patients. Ann Thorac Surg 72:2013-9.nIchikawa A, Taki J, Nakajima K, et al. 1997. Evaluation of the graft flow reserve after coronary artery bypass grafting by stress 201T1 myocardial SPECT: comparison between arterial grafts and venous grafts. Kaku Igaku 34:19-23.n
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