title: Results of completion arteriography after minimally invasive off-pump coronary artery bypass.
abstract: BACKGROUND
  The benefits of a minimally invasive approach to off-pump coronary artery bypass remain controversial. The value of completion arteriography in validating this technique has not been investigated.
  
  
  METHODS
  From April 2007 to October 2009, fifty-six patients underwent isolated minimally invasive coronary artery bypass grafting through a left thoracotomy without cardiopulmonary bypass. Forty-three of these patients underwent completion arteriography.
  
  
  RESULTS
  Sixty-five grafts were performed in these 56 patients, (average, 1.2 grafts per patient; range, 1 to 3). Forty-eight grafts were studied in the 43 patients undergoing completion arteriography. There were 4 findings on arteriogram leading to further immediate intervention (8.3%). These included 3 grafts with anastomotic stenoses or spasm requiring stent placement, and 1 patient who had limited dissection in the left internal mammary artery graft and underwent placement of an additional vein graft. These findings were independent of electrocardiographic changes or hemodynamic instability. The remainder of the studies showed no significant abnormalities. There were no deaths. One patient who did not have a completion arteriogram suffered a postoperative myocardial infarction requiring stent placement for anastomotic stenosis. Patients were discharged home an average of 6.8 days postoperatively. There were no instances of renal dysfunction postoperatively attributable to catheterization.
  
  
  CONCLUSIONS
  Minimally invasive coronary artery bypass is safe and effective. Findings of completion arteriography occasionally reveal previously under-recognized findings that, if corrected in a timely fashion, could potentially impact graft patency and clinical outcomes. Our experience validates this minimally invasive technique.
authors.affiliation: Department of Cardiac Surgery, Vanderbilt Heart and Vascular Institute, Nashville, Tennessee 37232-8802, USA. steve.hoff@vanderbilt.edu
authors.forename: Steven J
authors.initials: SJ
authors.lastname: Hoff
authors.forename: Stephen K
authors.initials: SK
authors.lastname: Ball
authors.forename: Marzia
authors.initials: M
authors.lastname: Leacche
authors.forename: Natalia
authors.initials: N
authors.lastname: Solenkova
authors.forename: Ramanan
authors.initials: R
authors.lastname: Umakanthan
authors.forename: Michael R
authors.initials: MR
authors.lastname: Petracek
authors.forename: Rashid
authors.initials: R
authors.lastname: Ahmad
authors.forename: James P
authors.initials: JP
authors.lastname: Greelish
authors.forename: Kristie
authors.initials: K
authors.lastname: Walker
authors.forename: John G
authors.initials: JG
authors.lastname: Byrne
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D017023:Coronary Angiography; D047549:Coronary Artery Bypass, Off-Pump / Q000009:adverse effects / Q000379:methods*; D003324:Coronary Artery Disease / Q000150:complications / Q000000981:diagnostic imaging* / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D012189:Retrospective Studies; D016896:Treatment Outcome