Intraoperative Color Doppler Ultrasound Assessment of Anastomoses of the Left Internal Mammary Artery to the Left Anterior Descending Coronary Artery during Off-Pump Coronary Artery Bypass Surgery Correlates with Angiographic Evaluation at the 8-Mont
Objective: This study was performed to evaluate the correlation between intraoperative color Doppler ultrasound assessment of anastomoses of the left internal mammary artery (LIMA) to the left anterior descending coronary artery (LAD) performed on the beating heart and the angiographic assessment after 8 months.
Methods: Twenty patients (M/F ratio, 14:6; mean age, 62 ± 8 years) underwent epicardial color Doppler ultrasound imaging with a 10-MHz linear array GE Vingmed transducer combined with a GE Vingmed System FiVe. Transit-time flowmetry was used as intraoperative control. Follow-up coronary angiography after a median of 245 days (range, 128-320 days) allowed assessment of thrombolysis in myocardial infarction (TIMI) flow and FitzGibbon grading in all patients. Detailed quantitative coronary angiography was performed in 10 patients with an emphasis on comparing the LAD diameter at the toe of the anastomosis (D1) and in the downstream LAD (D2).
Results: Intraoperative ultrasound analysis revealed 19 patent LIMA-LAD anastomoses (95%). A >50% stenosis was detected in 1 anastomosis (5%), which was subsequently revised successfully. Follow-up angiographic evaluation showed TIMI-III flow and FitzGibbon grade A in 18 of 20 anastomoses (90%). One anastomosis was occluded, and one had FitzGibbon grade B stenosis. The D1/D2 ratios of the LAD measurements assessed with intraoperative ultrasound and follow-up quantitative coronary angiography were significantly correlated (r2 = 0.62; P < .01).
Conclusion: Intraoperative color Doppler ultrasound allows a detailed evaluation of LIMA-LAD anastomoses during off-pump surgery, and the results correlate significantly with those of angiographic evaluation after 8 months. The present study shows that epicardial ultrasound is a promising tool for verification of LIMA-LAD anastomoses performed on the beating heart and may reduce the risk of impaired graft flow caused by technical errors.
Barstad RM, Fosse E, Vatne K, et al. 1997. Intraoperative angiography in minimally invasive direct coronary artery bypass grafting. Ann Thorac Surg 64:1835-9.nBerger PB, Alderman EL, Nadel A, Schaff HV. 1999. Frequency of early occlusion and stenosis in a left internal mammary artery to left anterior descending artery bypass graft after surgery through a median sternotomy on conventional bypass: benchmark for minimally invasive direct coronary artery bypass. Circulation 100:2353-8.nD'Ancona G, Karamanoukian HC, Salerno TA, Schmid S, Bergsland J. 1999. Flow measurement in coronary surgery. Heart Surg Forum 2:121-4.nDiegeler A, Matin M, Kayser S, et al. 1999. Angiographic results after minimally invasive coronary bypass grafting using the minimally invasive direct coronary bypass grafting (MIDCAB) approach. Eur J Cardiothorac Surg 15:680-4.nElbeery JR, Brown PM, Chitwood WR Jr. 1998. Intraoperative MID-CABG arteriography via the left radial artery: a comparison with Doppler ultrasound for assessment of graft patency. Ann Thorac Surg 66:51-5.nJaber SF, Koenig SC, BhaskerRao B, et al. 1998. Role of graft flow measurements technique in anastomotic quality assessment in minimally invasive CABG. Ann Thorac Surg 66:1087-92.nJatene FB, Pego-Fernandes PM, Hueb AC, et al. 2000. Angiographic evaluation of graft patency in minimally invasive direct coronary artery bypass grafting. Ann Thorac Surg 70:1066-9.nLazzara RR, McMellan BA, Kidwell FE, Combs DT, Hanlon JT, Young EK. 1997. Intraoperative angiography during minimally invasive direct coronary artery bypass operations. Ann Thorac Surg 64:1725-7.nYavuz S, Celkan A, Goncu T, Turk T, Ozdemir IA. 2001. Effect of papaverine applications on blood flow of the internal mammary artery. Ann Thorac Cardiovasc Surg 7:84-8.nGoldstein JA, Safian RD, Aliabadi D, et al. 1998. Intraoperative angiography to assess graft patency after minimally invasive coronary bypass. Ann Thorac Surg 66:1978-82.nGrover FL, Johnson RR, Marshall G, Hammermeister KE. 1994. Impact of mammary grafts on coronary bypass operative mortality and morbidity: Department of Veterans Affairs Cardiac Surgeons. Ann Thorac Surg 57:559-68.nHaaverstad R, Vitale N, Tjomsland O, Tromsdal A, Torp H, Samstad SO. 2002. Intraoperative color Doppler ultrasound assessment of LIMA-to-LAD anastomoses in off-pump coronary artery bypass grafting. Ann Thorac Surg 74:S1390-4.nHaaverstad R, Vitale N, Williams RI, Fraser AG. 2002. Epicardial colour-Doppler scanning of coronary artery stenoses and graft anastomoses. Scand Cardiovasc J 36:95-9.nHol PK, Fosse E, Lundblad R, et al. 2002. The importance of intraoperative angiographic findings for predicting long-term patency in coronary artery bypass operations. Ann Thorac Surg 73:813-8.nHol PK, Fosse E, Mork BE, et al. 2001. Graft control by transit time flow measurement and intraoperative angiography in coronary artery bypass surgery. Heart Surg Forum 4:254-7.n
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