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Coronary Angiography During Ex-Situ Heart Perfusion in a Porcine Model
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Functional and perfusional assessment with electrocardiograph-gated single photon emission computed tomography after

K Nishizaki1, Y Kameda, T Kawata

  • 1Department of Surgery III, Nara Medical University, 840 Shijo-cho, Kashihara, Nara 634-8522, Japan.

Annals of Thoracic and Cardiovascular Surgery : Official Journal of the Association of Thoracic and Cardiovascular Surgeons of Asia
|May 24, 2001
PubMed

Insights

Minimally invasive coronary artery bypass grafting (MIDCAB) improved blood flow and heart function in the left anterior descending artery (LAD) territory. Quantitative ECG-gated SPECT (QGS) effectively assessed anastomosis quality after MIDCAB surgery.

Area of Science:

  • Cardiovascular Surgery
  • Minimally Invasive Cardiac Surgery
  • Coronary Artery Bypass Grafting

Background:

  • Minimally invasive coronary artery bypass grafting (MIDCAB) involves anastomosing the left internal thoracic artery (LITA) to the left anterior descending artery (LAD) on a beating heart.
  • Challenges in MIDCAB include limited surgical fields and the small diameters of the LITA and LAD, raising questions about achieved blood flow sufficiency.
  • The effectiveness of MIDCAB in improving perfusion and function in the LAD territory remains an area of investigation.

Purpose of the Study:

  • To evaluate the perfusion and function of the left anterior descending (LAD) artery territory after minimally invasive coronary artery bypass grafting (MIDCAB).
  • To assess the utility of quantitative ECG-gated SPECT (QGS) with 99m-technetium sestamibi (MIBI) in evaluating anastomosis quality post-MIDCAB.

Main Methods:

  • Eight patients with single-vessel disease of the LAD underwent MIDCAB using the LITA to LAD bypass.
  • Quantitative ECG-gated SPECT (QGS) with 99m-technetium sestamibi (MIBI) was performed before and after surgery to assess LAD territory perfusion and function.
  • Intraoperative diameters of the LITA and LAD at the anastomosis site were measured.

Main Results:

  • Intraoperative LITA and LAD diameters at anastomosis were 1.1+/-0.2 mm and 1.3+/-0.4 mm, respectively.
  • Significant improvements were observed post-MIDCAB in end-diastolic perfusion (136.3+/-11.7%), regional ejection fraction (148.4+/-6.6%), and regional wall thickening (133.0+/-5.6%) in the anteroseptal area (p<0.05).
  • Stress-rest MIBI SPECT confirmed the absence of ischemia in the anteroseptal wall post-operatively.

Conclusions:

  • MIDCAB surgery effectively enhances perfusion and cardiac function in the LAD territory, even with distal LAD anastomosis.
  • ECG-gated MIBI SPECT utilizing QGS software is a valuable tool for assessing the quality of coronary artery bypass anastomosis after MIDCAB.
  • The study demonstrates the clinical utility of MIDCAB for LAD revascularization and the diagnostic capability of SPECT imaging.
Abstract

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