Intraoperative MIDCABG arteriography via the left radial artery: a comparison with Doppler ultrasound for assessment of graft patency.
BACKGROUND
Minimally invasive direct coronary artery bypass grafting involving beating heart left internal mammary artery to left anterior descending coronary artery anastomoses are performed with increasing frequency. Controversy exists regarding the need for intraoperative assessment of graft patency.


METHODS
We designed a technique to perform arteriography of the left internal mammary artery by using left radial artery access and standard fluoroscopy to evaluate patency in the operating room. The last 50 of 87 minimally invasive direct coronary artery bypass grafting operations were evaluated by intraoperative arteriography and Doppler ultrasound. Angiograms were performed by the surgeon and involved cannulation and direct injection of contrast medium into the origin of the left internal mammary artery via the left radial artery.


RESULTS
Total procedure time was less than 15 minutes. No injuries to the left internal mammary artery were identified. Anastomotic occlusions were identified in 4 cases (8%), 2 of which involved sequential diagonal and left anterior descending anastomoses. These were corrected at the time of surgery with 2 cases requiring conversion to standard coronary artery bypass grafting. Qualitative assessment of grafts with Doppler ultrasound failed to definitively identify these occlusions. There were no deaths and no perioperative infarctions.


CONCLUSIONS
Intraoperative arteriography of the left internal mammary artery can be performed by the surgeon, and a significant number of anastomotic problems may be identified and corrected by using this technique. Therefore, a 100% early graft patency rate may be attainable.
Division of Cardiothoracic Surgery, East Carolina University School of Medicine, Greenville, North Carolina 27858-4354, USA. elbeery@brody.med.ecu.edu
J R
JR
Elbeery
P M
PM
Brown
W R
WR
Chitwood
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002406:Catheterization, Peripheral; D003287:Contrast Media / Q000008:administration & dosage; D017023:Coronary Angiography; D001026:Coronary Artery Bypass; D003331:Coronary Vessels / Q000000981:diagnostic imaging*; D005069:Evaluation Studies as Topic; D005260:Female; D005471:Fluoroscopy; D006083:Graft Occlusion, Vascular / Q000000981:diagnostic imaging; D006801:Humans; D007387:Internal Mammary-Coronary Artery Anastomosis / Q000009:adverse effects / Q000379:methods*; D007430:Intraoperative Care; D007431:Intraoperative Complications / Q000517:prevention & control; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D009203:Myocardial Infarction / Q000517:prevention & control; D017534:Radial Artery; D015641:Radiography, Interventional; D015996:Survival Rate; D013997:Time Factors; D018608:Ultrasonography, Doppler; D018084:Ultrasonography, Interventional; D014654:Vascular Patency
D003287:Contrast Media