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Impact of Completion Angiogram After Surgical Coronary Revascularisation.
S. Kumar, R. Ahmad, J. Balaguer, J. Greelish, D. Zhao, M. Petracek, J. Byrne. Vanderbilt Heart Institute, Nashville, TN,
BACKGROUND:Coronary bypass surgery (CABG) does not traditionally employ immediate completion angiography to assess procedural success. However, early (1-yr) graft failure is reported up to 30% (JAMA Nov 2005) and may relate to technical errors or conduit problems. We hypothesize that intra-operative assessment of graft integrity by angiography identifies graft defects and guides appropriate percutaneous or surgical revisions without increasing immediate adverse outcomes.
METHODS:
We have developed one of the first hybrid catheterization and operation room in the USA. Between April 2005 and April 2006, 203 consecutive patients (age: 63±16, M/F: 126/39) underwent CABG with intraoperative completion angiography immediately after cessation cardiopulmonary bypass before closing the chest.
RESULTS:
Of 436 grafts, 72 angiographic defects were detected in 69 grafts (17% of total grafts). There were 48/436 (11%) conduit defects, 13/436 (3%) anastomotic defects, and 11/436 (3%) target vessel error. Of 72 defects, 25/72 (35%) defects required minor revision. 47/72 (65%) defects required surgical (18/47, 38%) or percutaneous (29/47, 62%) revision. Intra-operative angiography added an average 20±12 minutes to the surgery and 112±56 ml contrast (Visipaque). Renal function at 24hours and 48 hours after procedure did not vary significantly between patients who did vs. those did not have revisions. There were no significant differences in cardiopulmonary bypass time, aortic cross clamp time, and length of hospital stay for patients who underwent revision compared to those who did not. Renal function, bleeding complication, transfusion were similar in patients with percutaneous vs. surgical revision.
CONCLUSIONS:
Intraoperative graft angiography performed at the time of CABG identifies graft defects, allowing for immediate surgical or percutaneous revision. Long-term study is in progress to assess whether intra-operative completion angiography decreases the rate of early graft failure.
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