Frequent change of procedure during coronary artery bypass surgery suggests insufficient preoperative diagnostic strategy.
We sought to evaluate how often and in what way surgeons change peroperatively their preoperative coronary artery bypass grafting strategy and to what degree these changes affect postoperative graft patency. A series of 109 patients with stable angina pectoris and at least one occluded coronary artery participated. The surgeon filled in a questionnaire pertaining to the planned localization and number of grafts. These estimates were compared to procedures actually performed and with the angiographic outcome six months after bypass surgery. Planned and actually inserted grafts disclosed a discrepancy in 22% of the patients, resulting in a lower or higher number of grafts than pre-operatively estimated. The difference in shift rates between the three sites, left anterior descending, left circumflex, and right coronary artery, was significant (P=0.014). Patency rates were highest when only preoperatively planned grafts were inserted. When shifts occurred, no matter in which direction, it resulted in a decreased patency rate of the inserted grafts. This finding was significant for LAD (P=0.037). Our findings might indicate the necessity of future studies with the use of scintigraphy or fractional flow reserve as physiological adjuncts to angiography for more targeted revascularization.
Department of Cardiothoracic Surgery, Institute of Clinical Research, Odense University Hospital, 5000 Odense C, Denmark. rozy.eckardt@ouh.fyns-amt.dk
Rozy
R
Eckardt
Bo Juel
BJ
Kjeldsen
Per
P
Thayssen
Werner
W
Vach
Torben
T
Haghfelt
Poul F
PF
Høilund-Carlsen
Larsib
L
Andersen
D016009:Chi-Square Distribution; D017023:Coronary Angiography; D001026:Coronary Artery Bypass / Q000379:methods*; D003327:Coronary Disease / Q000000981:diagnostic imaging / Q000601:surgery*; D003657:Decision Making; D006801:Humans; D017063:Outcome Assessment, Health Care; D010347:Patient Care Planning / Q000592:standards*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011446:Prospective Studies; D018709:Statistics, Nonparametric; D011795:Surveys and Questionnaires; D014654:Vascular Patency