title: Intraoperative angiography during minimally invasive direct coronary artery bypass operations.
abstract: BACKGROUND
  The technical demands of beating heart operations raise concerns about anastomotic patency. This feasibility study tested the usefulness of intraoperative angiography during minimally invasive direct coronary artery bypass grafting (MIDCABG).
  
  
  METHODS
  Ten patients underwent intraoperative angiography of the internal thoracic artery (ITA) after MIDCABG. Minimally invasive direct coronary artery bypass grafting was performed on a beating heart through the fourth or fifth intercostal space. Angiography was performed through the right or left femoral artery with a 7F introducer system placed before the operation. Views were obtained in the right and left anterior oblique and straight anterior projections.
  
  
  RESULTS
  There were no deaths or intraoperative morbidities related to MIDCABG or angiography. Seven patients demonstrated widely patent MIDCABG anastomoses with obliteration of all intercostals, widely patent ITA pedicles, good distal runoff, and placement of the ITA into the proper native coronary artery. Two patients had revisions of their ITA pedicles, which on repeated angiography showed correction. One patient's procedure was converted to a sternotomy because of poor distal runoff and haziness at the level of the MIDCABG anastomosis.
  
  
  CONCLUSIONS
  This feasibility study demonstrates the utility of intraoperative ITA angiography in identifying problems after MIDCABG. Intraoperative angiography may facilitate MIDCABG by documenting proper placement of conduits, obliteration of intercostal vessels, and patency of the MIDCABG anastomosis and ITA pedicle.
authors.affiliation: Division of Cardiac Services, St. Charles Medical Center, Bend, Oregon, USA. hsurg@aol.com
authors.forename: R R
authors.initials: RR
authors.lastname: Lazzara
authors.forename: B A
authors.initials: BA
authors.lastname: McLellan
authors.forename: F E
authors.initials: FE
authors.lastname: Kidwell
authors.forename: D T
authors.initials: DT
authors.lastname: Combs
authors.forename: J T
authors.initials: JT
authors.lastname: Hanlon
authors.forename: E K
authors.initials: EK
authors.lastname: Young
mesh_terms: D000368:Aged; D000792:Angiography; D001026:Coronary Artery Bypass / Q000379:methods*; D005240:Feasibility Studies; D006801:Humans; D019060:Minimally Invasive Surgical Procedures; D016343:Monitoring, Intraoperative / Q000379:methods; D014654:Vascular Patency