Clin Res Cardiol 96:Suppl 2 (2007)

P366 - Intra- and postoperative quality control after total arterial revascularisation: cooperation between surgeons, cardiologists and radiologists
M. Shrestha1, N. Khaladj1, C. Bara1, J. Weidemann2, M. Maringka1, A. Haverich1, C. Hagl1
1Herz-, Thorax-, Transplantations- und Gefäßchirurgie, Medizinische Hochschule Hannover, Hannover; 2Diagnostische Radiologie, Medizinische Hochschule Hannover, Hannover;
Introduction: Quality control after total arterial revascularisation (TAR) is still controversial. Coronary angiography (CAG) is conventionally regarded as the gold standard in evaluating graft patency following coronary artery bypass grafting (CABG). Recently developed multi-slice CT (MSCT), having effective scan times up to 0.25 s and multi-row detector array systems, enable rapid imaging of cardiac structures, including coronary arteries. Therefore in our institution a pilot study was performed combinining these procedures.
Patients and Methods: From April to May 2006, as part of our evaluation of graft patency, 13 patients, who had received total arterial revascularization using composite left internal thoracic artery (LITA) and left radial artery (RA) as T-graft, were evaluated. Intraoperative angiography had been performed in these patients at the time of surgery (July 2004 to March 2005) to confirm 100% graft patency. Follow-up control (9-21 months) was performed with exercise ergometry and 64 slides MSCT.
Result: Mean procedure time for intraoperative angiography was 13.7 ± 7.3 minutes and mean fluoroscopy time was 6.2 ± 4.6 minutes. In two patients, RA-marginal artery side to side anastomoses was stenosed and had to be revised as shown by the graft angiography. In one patient, the RA was kinked and in another, there was a kinking of the LITA. In both cases kinking was corrected.
At follow-up, exercise ergometry showed no signs of angina or ECG-changes in all patients. MSCT showed occluded radial artery grafts in 2 patients. In 2 other patients interpretation was difficult due to resolution reasons. In all patients the LITA graft was patent.
Conclusion: The intraoperative graft angiography can be performed in patients undergoing TAR easily. Follow-up results showed excellent physical status and quality of life in all patients, including the 2 patients with occluded radial artery graft segment. MSCT can be used for postoperative non-invasive angiography with limitations in patients with small graft/coronary diameters and arrhythmias.
This pilot study shows that a interdisziplinary cooperation is a new possibility towards quality control after CABG.