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Ann Thorac Surg 2004;78:502-505
© 2004 The Society of Thoracic Surgeons

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Original article: cardiovascular

Intraoperative angiography leads to graft revision in coronary artery bypass surgery

^a The Interventional Centre, Oslo, Norway
^b Department of Thoracic and Cardiovascular Surgery, Rikshospitalet University Hospital, Oslo, Norway
^c Department of Cardiology, Rikshospitalet University Hospital, Oslo, Norway
^d Department of Radiology, Rikshospitalet University Hospital, Oslo, Norway

Accepted for publication December 29, 2003.

^* Address reprint requests to Dr Hol, The Interventional Centre, Rikshospitalet University Hospital, N-0027 Oslo, Norway
e-mail: per.kristian.hol{at}rikshospitalet.no

BACKGROUND: Graft anastomosis quality in coronary artery bypass surgery can be assessed by intraoperative angiography. The aim of the present study was to quantify the on-table revision rate initiated by intraoperative angiography.

METHODS: Intraoperative angiography was carried out in 186 patients undergoing coronary artery bypass surgery, with a total of 427 grafts. The operation was performed on-pump in 34%, off-pump through a sternotomy in 49%, and as a minimally invasive direct coronary bypass grafting (MIDCAB) procedure in 17%. The angiography was performed intraoperatively while the patients were still in general anesthesia, with the possibility for on-table revision. Follow-up angiography was carried out after a mean of 346 days.

RESULTS: Eighteen of 427 grafts (4.2%) were revised due to the findings at intraoperative angiography. Revision rate after on-pump surgery was 1.1%, after off-pump through a sternotomy 6.4%, and after MIDCAB 6.5%. In 6 patients the lesions were located at the distal anastomoses and in 12 patients in the conduit. All but one was successfully revised, and at 1-year follow-up all these 17 grafts were patent.

CONCLUSIONS: Intraoperative angiography saves a potential number of grafts that otherwise could have been occluded. An increased implementation of intraoperative quality assessment in coronary artery bypass surgery can lead to improved outcome.

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