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Ann Thorac Surg 2007;84:801-807
© 2007 The Society of Thoracic Surgeons

Original Articles: Cardiovascular

Epicardial Ultrasonography: A Potential Method for Intraoperative Quality Assessment of Coronary Bypass Anastomoses?

Per Kristian Hol, MDa,*, Kai Andersen, MD, PhDb, Helge Skulstad, MD, PhDc, Per Steinar Halvorsen, MDa, Per Snorre Lingaas, MDb, Rune Andersen, MDd, Jacob Bergsland, MDa, Erik Fosse, MD, PhDa,e

a The Interventional Centre, Rikshospitalet-Radiumhospitalet University Hospital, Oslo, Norway
b Department of Thoracic and Cardiovascular Surgery, Rikshospitalet-Radiumhospitalet University Hospital, Oslo, Norway
c Department of Cardiology, Rikshospitalet-Radiumhospitalet University Hospital, Oslo, Norway
d Department of Radiology, Rikshospitalet-Radiumhospitalet University Hospital, Oslo, Norway
e Medical Faculty, University of Oslo, Oslo, Norway

Accepted for publication April 5, 2007.

* Address correspondence to Dr Hol, The Interventional Centre, Rikshospitalet University Hospital, Oslo, NO-0027, Norway (Email: per.kristian.hol{at}rikshospitalet.no).

Background: Intraoperative quality assessment in coronary artery bypass surgery confirms graft patency and enables revision of failing grafts. The aim of this study was to evaluate graft quality intraoperatively by epicardial ultrasonography and to compare this technique with transit time flow measurements and intraoperative angiography, and to evaluate the ability of these methods to predict long-term patency as described by follow-up angiography.

Methods: Thirty-nine patients with mean age of 66 years (SD 9.5) who underwent off-pump coronary artery bypass surgery with internal mammary artery graft to the left anterior descending coronary artery were included. Epicardial ultrasonography and transit time flow measurement were performed after completion of the anastomoses, and coronary angiography after closure of the chest. Follow-up angiography was carried out after 156 days (SD 50).

Results: Diameter measurements obtained by epicardial ultrasonography correlated poorly with the same diameter measurements obtained by angiography. Epicardial ultrasonography revealed 5 abnormal grafts (13%), transit time flow measurements none, and intraoperative angiography 9 (23%). At follow-up angiography, 4 grafts (11%) were pathologic. Epicardial ultrasonography and transit time flow measurements indicated no need for graft revision; intraoperative angiography suggested need for revision in 3 cases.

Conclusions: Epicardial ultrasonography could be a useful method for intraoperative assessment of graft anastomosis quality, but needs to demonstrate its ability to predict grafts in need of revision. Angiography must be considered the gold standard in intraoperative imaging.






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