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Ann Thorac Surg 1998;66:51-55
© 1998 The Society of Thoracic Surgeons
a Division of Cardiothoracic Surgery, East Carolina University School of Medicine, Greenville, North Carolina, USA
Address reprint requests to Dr Elbeery, Division of Cardiothoracic Surgery, East Carolina University School of Medicine, 600 Moye Blvd, Greenville, NC 27858-4354
e-mail: (elbeery{at}brody.med.ecu.edu)
Presented at the Forty-fourth Annual Meeting of the Southern Thoracic Surgical Association, Naples, FL, Nov 6–8, 1997.
Background. Minimally invasive direct coronary artery bypass grafting involving beating heart left internal mammary artery to left anterior descending coronary artery anastomoses are performed with increasing frequency. Controversy exists regarding the need for intraoperative assessment of graft patency.
Methods. We designed a technique to perform arteriography of the left internal mammary artery by using left radial artery access and standard fluoroscopy to evaluate patency in the operating room. The last 50 of 87 minimally invasive direct coronary artery bypass grafting operations were evaluated by intraoperative arteriography and Doppler ultrasound. Angiograms were performed by the surgeon and involved cannulation and direct injection of contrast medium into the origin of the left internal mammary artery via the left radial artery.
Results. Total procedure time was less than 15 minutes. No injuries to the left internal mammary artery were identified. Anastomotic occlusions were identified in 4 cases (8%), 2 of which involved sequential diagonal and left anterior descending anastomoses. These were corrected at the time of surgery with 2 cases requiring conversion to standard coronary artery bypass grafting. Qualitative assessment of grafts with Doppler ultrasound failed to definitively identify these occlusions. There were no deaths and no perioperative infarctions.
Conclusion. Intraoperative arteriography of the left internal mammary artery can be performed by the surgeon, and a significant number of anastomotic problems may be identified and corrected by using this technique. Therefore, a 100% early graft patency rate may be attainable.
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