Early and 1 year angiographic evaluation of graft patency in off-pump coronary bypass surgery via sternotomy.
The goal of this study was to evaluate the early and 1 year postoperative angiographic results in patients who underwent coronary revascularisation for multivessel disease on beating heart via sternotomy. One hundred eleven consecutive patients receiving 272 grafts, operated by the same surgeon were studied (2.5 grafts/patient). The quality of the graft and the anastomoses was systematically evaluated by coronary angiography between 1 and 15 days after surgery. Eighty-seven patients (209 grafts) of the initial cohort (78.3%) were repeatedly controlled by angiography between 5 and 24 months. Angiographic findings were studied and classified according to Fitzgibbon classification. Overall early graft patency was 96.4%. Arterial graft patency was 96.4% and vein graft patency was 96.3% (P=1). Of the grafts (88.7%) were Grade A, 21 grafts (7.7%) Grade B and 10 grafts (3.6%) were occluded (Grade O). The second angiographic control revealed a patency rate of 94.8%, arterial graft patency was 95.4% and vein graft patency was 93.8% (P=0.9): 91.5% of patent grafts were graded (A), 3.3% graded (B) and 5.2% graded (O). A comparison between early and late angiograms revealed: two-stenosis de novo, three-occlusion de novo and decrease or disappearance of the stenosis in 13/21 graft, 11 arterial and two vein grafts (61.9%). In this study, the early and 1 year postoperative patency rate seems to be equivalent to coronary bypass with pump, however, a randomised study is needed to compare both approaches. Most of the stenosis detected at the early coronary angiography could decrease or disappear, especially in arterial grafts.
Department of Cardio-thoracic Surgery, Laennec Hospital, University of Nantes, Nantes 44000, France. ousama.alhabash@chu-nantes.fr
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Alhabash
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Tirouvanziam
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Roussel
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Duveau