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Quantitative angiographic assessment of coronary anastomoses performed without cardiopulmonary bypass
N C Poirier1, M Carrier, J Lespérance
1Department of Surgery and the Cardiac Catheterization Laboratory, Montreal Heart Institute, Quebec, Canada.
Insights
Myocardial wall stabilizers significantly reduce stenosis in coronary artery bypass grafting (CABG) anastomoses. Using a stabilizer during off-pump CABG with left internal thoracic artery to left anterior descending artery grafts resulted in fewer anastomotic stenoses.
Area of Science:
- Cardiovascular Surgery
- Medical Devices
- Interventional Cardiology
Background:
- Coronary artery bypass grafting (CABG) without cardiopulmonary bypass is a critical procedure.
- Ensuring high-quality anastomoses is essential for successful outcomes.
- Myocardial wall restraining devices are developed to improve surgical results.
Purpose of the Study:
- To quantitatively assess coronary anastomoses performed on beating hearts.
- To evaluate the impact of myocardial wall stabilizers on anastomosis quality.
- To compare stenosis rates in grafts with and without stabilizers.
Main Methods:
- A quantitative angiographic analysis was conducted on 34 patients undergoing off-pump CABG.
- The left internal thoracic artery was anastomosed to the left anterior descending coronary artery in all cases.
- Computer-assisted analysis quantified anastomosis diameters and identified stenoses.
Main Results:
- 40% of patients without a stabilizer experienced >50% stenosis at the anastomosis.
- Only 1 patient (7%) using a stabilizer had >50% stenosis.
- The use of a myocardial wall stabilizer was associated with significantly lower stenosis rates (P = .02).
Conclusions:
- Off-pump CABG anastomoses demonstrate reduced intraluminal stenosis when myocardial wall stabilizers are employed.
- Stabilizers appear to enhance the quality of left internal thoracic artery to left anterior descending artery grafts.
- This suggests a benefit of using myocardial wall stabilizers in specific CABG procedures.
Background:
The quality of the anastomosis performed during coronary artery bypass grafting without cardiopulmonary bypass is a current concern, and myocardial wall restraining devices have been designed to optimize results. A quantitative angiographic analysis was performed to assess coronary anastomoses performed on beating hearts.
Methods:
We studied 34 patients who underwent coronary artery bypass grafting without cardiopulmonary bypass between February 1996 and April 1997. The left internal thoracic artery was anastomosed to the left anterior descending coronary artery in all patients. Coronary angiograms were performed 4 +/- 2 days after the operation. The diameter of the anastomoses was quantified by computer-assisted analysis of grafts and native coronary arteries at the toe and heel of the anastomosis.
Results:
Five of the patients who underwent coronary artery bypass without a stabilizer (n = 20) had stenoses of the internal thoracic artery grafted to the left anterior descending coronary artery of more than 50% at the level of the anastomosis proper, 3 had stenoses at the heel of the coronary anastomosis, and 5 had stenoses at the toe. One of the patients in whom a stabilizer was used (n = 14) had a stenosis of more than 50% at the anastomosis, and 1 had stenosis at the heel. Eight patients in whom the anastomoses were performed without stabilization (8/20, 40%) had stenoses of more than 50%, whereas there was only 1 stenosis of more than 50% of coronary luminal diameter among the patients in whom the operation was performed with a stabilizer (P =.02).
Conclusion:
The quantitative angiographic evaluation suggests that left internal thoracic artery graft to left anterior descending coronary artery anastomoses have a lesser degree of intraluminal stenosis when performed with the use of a myocardial wall stabilizer.