title: Routine intraoperative completion angiography after coronary artery bypass grafting and 1-stop hybrid revascularization results from a fully integrated hybrid catheterization laboratory/operating room.
abstract: OBJECTIVE
  This study sought to report our experience with a routine completion angiogram after coronary artery bypass surgery (CABG) and simultaneous (1-stop) percutaneous coronary intervention (PCI) at the time of CABG performed in the hybrid catheterization laboratory/operating room.
  
  
  BACKGROUND
  The value of a routine completion angiogram after CABG and 1-stop hybrid CABG/PCI remains unresolved.
  
  
  METHODS
  Between April 2005 and July 2007, 366 consecutive patients underwent CABG surgery, with (n = 112) or without (n = 254) concomitant 1-stop PCI (hybrid), all with completion angiography before chest closure. Among the 112 1-stop hybrid CABG/PCI patients, 67 (60%) underwent a planned hybrid procedure based on pre-operative assessment, whereas 45 (40%) underwent open-chest PCI (unplanned hybrid) based on intraoperative findings.
  
  
  RESULTS
  Among the 796 CABG grafts (345 left internal mammary artery, 12 right internal mammary artery/radial, and 439 veins), 97 (12%) angiographic defects were identified. Defects were repaired with either a minor adjustment of the graft (n = 22, 2.8%), with intraoperative open-chest PCI (unplanned hybrid, n = 48, 6%) or with traditional surgical revision (n = 27, 3.4%). Hybrid patients had clinical outcomes similar to standard CABG patients.
  
  
  CONCLUSIONS
  Routine completion angiography detected 12% of grafts with important angiographic defects. One-stop hybrid coronary revascularization is reasonable, safe, and feasible. Combining the tools of the catheterization laboratory and operating room greatly enhances the options available to the surgeon and cardiologist for patients with complex coronary artery disease.
authors.affiliation: Vanderbilt Heart and Vascular Institute, Nashville, Tennessee, USA.
authors.forename: David X
authors.initials: DX
authors.lastname: Zhao
authors.forename: Marzia
authors.initials: M
authors.lastname: Leacche
authors.forename: Jorge M
authors.initials: JM
authors.lastname: Balaguer
authors.forename: Konstantinos D
authors.initials: KD
authors.lastname: Boudoulas
authors.forename: Julie A
authors.initials: JA
authors.lastname: Damp
authors.forename: James P
authors.initials: JP
authors.lastname: Greelish
authors.forename: John G
authors.initials: JG
authors.lastname: Byrne
authors.forename: Rashid M
authors.initials: RM
authors.lastname: Ahmad
authors.forename: Stephen K
authors.initials: SK
authors.lastname: Ball
authors.forename: John H
authors.initials: JH
authors.lastname: Cleator
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Deegan
authors.forename: Susan S
authors.initials: SS
authors.lastname: Eagle
authors.forename: Pete P
authors.initials: PP
authors.lastname: Fong
authors.forename: Joseph L
authors.initials: JL
authors.lastname: Fredi
authors.forename: Steven J
authors.initials: SJ
authors.lastname: Hoff
authors.forename: Henry S
authors.initials: HS
authors.lastname: Jennings
authors.forename: John A
authors.initials: JA
authors.lastname: McPherson
authors.forename: Robert N
authors.initials: RN
authors.lastname: Piana
authors.forename: Mias
authors.initials: M
authors.lastname: Pretorius
authors.forename: Mark A
authors.initials: MA
authors.lastname: Robbins
authors.forename: David A
authors.initials: DA
authors.lastname: Slosky
authors.forename: Annemarie
authors.initials: A
authors.lastname: Thompson
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects / Q000379:methods*; D006328:Cardiac Catheterization / Q000379:methods; D015331:Cohort Studies; D003131:Combined Modality Therapy; D017023:Coronary Angiography / Q000379:methods*; D001026:Coronary Artery Bypass / Q000009:adverse effects / Q000379:methods*; D003327:Coronary Disease / Q000000981:diagnostic imaging* / Q000601:surgery* / Q000628:therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007430:Intraoperative Care / Q000379:methods; D008297:Male; D008875:Middle Aged; D009873:Operating Rooms; D011336:Probability; D015641:Radiography, Interventional; D012189:Retrospective Studies; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D018709:Statistics, Nonparametric; D015607:Stents; D016896:Treatment Outcome; D014654:Vascular Patency