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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

Clinical Research in Cardiology : Official Journal of the German Cardiac Society

|January 15, 2008

Summary

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.

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Improved Registration of 3D CT Angiography with X-ray Fluoroscopy for Image Fusion During Transcatheter Aortic Valve Implantation

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Published on: June 3, 2018

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.