title: Epicardial ultrasonography: a potential method for intraoperative quality assessment of coronary bypass anastomoses?
abstract: 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.
authors.affiliation: The Interventional Centre, Rikshospitalet-Radiumhospitalet University Hospital, Oslo, Norway. per.kristian.hol@rikshospitalet.no
authors.forename: Per Kristian
authors.initials: PK
authors.lastname: Hol
authors.forename: Kai
authors.initials: K
authors.lastname: Andersen
authors.forename: Helge
authors.initials: H
authors.lastname: Skulstad
authors.forename: Per Steinar
authors.initials: PS
authors.lastname: Halvorsen
authors.forename: Per Snorre
authors.initials: PS
authors.lastname: Lingaas
authors.forename: Rune
authors.initials: R
authors.lastname: Andersen
authors.forename: Jacob
authors.initials: J
authors.lastname: Bergsland
authors.forename: Erik
authors.initials: E
authors.lastname: Fosse
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical; D017023:Coronary Angiography; D047549:Coronary Artery Bypass, Off-Pump / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000379:methods*; D010496:Pericardium / Q000000981:diagnostic imaging*; D014463:Ultrasonography; D014654:Vascular Patency