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Quality control after total arterial revascularisation: multislice computer tomography cannot replace coronary
Malakh Shrestha1, Nawid Khaladj, Christoph Bara
1Dept. of Cardiac, Thoracic, Transplantation and Vascular Surgery, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany. Shrestha.Malakh.Lal@mh-hannover.de
Insights
Intra-operative angiography and multi-slice CT (MSCT) assess coronary artery bypass graft (CABG) patency. While MSCT offers less invasive follow-up, graft resolution can be challenging, highlighting the need for interdisciplinary quality control.
Area of Science:
- Cardiovascular Surgery
- Diagnostic Imaging
- Interventional Cardiology
Background:
- Coronary angiography is the gold standard for evaluating bypass graft patency.
- Multi-slice CT (MSCT) offers a potentially less invasive method for imaging coronary arteries.
Purpose of the Study:
- To prospectively evaluate the combination of intra-operative angiography and follow-up MSCT for assessing graft patency after coronary artery bypass grafting (CABG).
- To assess the feasibility and limitations of MSCT in post-operative graft surveillance.
Main Methods:
- A pilot study involving 13 patients undergoing CABG with composite T-grafts (left internal thoracic artery and radial artery).
- Intra-operative angiography was used for immediate graft assessment.
- Follow-up included exercise ergometry and 64-slice MSCT at 9-21 months.
Main Results:
- Intra-operative angiography confirmed graft patency with manageable procedure and fluoroscopy times.
- MSCT revealed occluded radial artery grafts in two patients and had interpretation difficulties in two others due to resolution.
- All left internal thoracic artery grafts remained patent; no angina or ECG changes were noted on follow-up ergometry.
Conclusions:
- Intra-operative graft angiography is easily performed during CABG.
- MSCT is a viable, less-invasive post-operative imaging option but has limitations with small graft/coronary diameters and arrhythmias.
- Interdisciplinary cooperation is essential for effective quality control during and after CABG.
Introduction:
Coronary angiography is regarded as the gold standard in evaluating graft patency, Multi-slice CT (MSCT) which enable rapid imaging of cardiac structures, including coronary arteries may be a less invasive technique. Therefore in our institution a prospective pilot study was performed combining these procedures.
Patients And Methods:
Starting from July 2004 a study was done with 13 patients. They received TAR using composite left internal thoracic artery (LITA) and left radial artery (RA) as T-graft. Intra-operative angiography was performed in these patients to confirm graft patency. Follow-up control (9-21 months) was performed with exercise Ergometry and 64 slides MSCT.
Result:
Mean procedure time for intra-operative angiography was 13.7 +/- 7.3 min and mean fluoroscopy time was 6.2 +/- 4.6 min. In one patient, RA-marginal artery side to side anastomoses was stenosed and had to be revised. And in another, there was a kinking of the LITA and was corrected. At follow-up, exercise ergometry showed no signs of angina or ECG-changes in all patients. MSCT showed occluded radial artery grafts in two patients. In two other patients interpretation was difficult due to resolution reasons. In all patients the LITA graft was patent.
Conclusion:
The intra-operative graft angiography can be performed in patients undergoing TAR easily. MSCT can be used for post-operative less-invasive angiography with limitations in patients with small graft/coronary diameters and arrhythmias. However, this study shows that an interdisciplinary cooperation is a new possibility toward quality control during and after TAR.
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