Surgical decision making for revascularization of chronically occluded right coronary artery
Andreas Borowski1, Erhard Godehardt2, Hannan Dalyanoglu2
1Clinic of Cardiovascular Surgery, University of Duesseldorf, Moorenstrasse 5, 40255, Duesseldorf, Germany. Borowski@med.uni-duesseldorf.de.
Insights
Qualitative angiograms and wall motion studies aid decisions for revascularizing chronic totally occluded right coronary arteries (CTO-RCA). Revascularizing non-viable CTO-RCA territories yields lower graft flows, indicating the need for viability tests before bypass surgery.
Area of Science:
- Cardiology
- Cardiac Surgery
- Interventional Cardiology
Background:
- Chronic totally occluded right coronary artery (CTO-RCA) presents challenges in surgical revascularization decisions due to a lack of standardized criteria.
- Qualitative angiographic assessment is explored as a tool to guide these decisions.
Purpose of the Study:
- To evaluate the utility of qualitative angiograms in determining the appropriateness of surgical revascularization for CTO-RCA.
- To analyze factors influencing graft flow in bypassed CTO-RCA.
Main Methods:
- Retrospective cohort study of 69 patients undergoing elective CABG with RCA bypass.
- Intraoperative measurement of distal run-off using the ultrasonic transit-time method.
- Analysis of correlations between graft flow, recipient artery diameter, regional/global LV function, Rentrop grading, collaterality, and comorbidities.
Main Results:
- Graft flow significantly correlated with recipient artery diameter.
- Lower flow and diameter values were observed in hypo/akinetic and infarcted CTO-RCA territories.
- Revascularization of akinetic/infarcted CTO-RCA territory resulted in lower graft flows, even with high Rentrop class and collaterality.
Conclusions:
- Qualitative angiograms combined with regional wall motion studies can aid in CTO-RCA revascularization decisions.
- Viability testing is recommended before bypass surgery for akinetic/infarcted CTO-RCA territories due to associated lower graft flows.
Objective:
Chronic totally occluded right coronary artery (CTO-RCA) often poses a problem in decision making for/against bypass grafting due to the lack of standardized indication criteria. The aim of the study was to investigate whether qualitative angiograms can be useful in decision making for/against surgical revascularization of CTO-RCA.
Methods:
A retrospective cohort study was conducted with 69 patients who underwent elective CABG procedure, including single graft to the RCA. The distal run-off of the bypassed RCA was measured intraoperatively using the ultrasonic transit-time method. As a primary endpoint of the study, the flow values were analysed in regard to diameter of the recipient artery. As a secondary endpoint, the correlations between the regional and global LV function, Rentrop grading, type of collateral pathway, number of donor sources, comorbidity, and the graft flow and the diameter of the recipient artery were investigated using uni- and multi-variate regression analyses.
Results:
In general, the flow values correlated significantly with the diameter of the recipient artery. Significantly lower flow (p < 0.0001) and diameter values (p < 0.05) were found in hypo/akinetic and infarcted area reflecting functionality of the CTO-RCA territory.
Conclusions:
The qualitative angiograms combined with regional wall motion studies can be useful in decision making for revascularization of CTO-RCA. Revascularization of akinetic/infarcted CTO-RCA territory is associated with lower graft flows even in patients presented with high Rentrop class and high degree of collaterality, suggesting necessity of viability tests prior to bypass surgery.
Related Concept Videos
01:27Coronary Artery Disease V: Interprofessional Care
01:28Acute Coronary Syndrome IV: Interprofessional Care
01:24Cardiac Catheterization III: Left Heart Catheterization
01:21Cardiac Catheterization II: Right Heart Catheterization