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Lognathen Balacumaraswami
Yasir Abu-Omar
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J Thorac Cardiovasc Surg 2004;128:238-244
© 2004 The American Association for Thoracic Surgery

Cardiopulmonary support and physiology

Does off-pump total arterial grafting increase the incidence of intraoperative graft failure?

Lognathen Balacumaraswami, FRCSa, Yasir Abu-Omar, MRCSa, Kyriakos Anastasiadis, MDa, Bikram Choudhary, MBBSa, David Pigott, FRCAb, Siu-Kae Yeongc, David P. Taggart, MD, PhD, FRCSa,*

a Departments of Department of Cardiothoracic Surgery, John Radcliffe Hospital, Oxford, United Kingdom,
b Department of Anaesthesia, John Radcliffe Hospital, Oxford, United Kingdom
c National Research Council of Canada, Ottawa, Ontario, Canada

Received for publication September 19, 2003; revisions received November 18, 2003; accepted for publication November 20, 2003.

* Address for reprints: David P. Taggart, MD, Department of Cardiothoracic Surgery, John Radcliffe Hospital, Headley Way, Headington, Oxford OX3 9DU, United Kingdom
david.taggart{at}orh.nhs.uk

BACKGROUND: Early graft failure is a common cause of cardiac mortality and morbidity after coronary artery bypass grafting, but there is little information on its natural incidence. Furthermore, there is particular concern about graft patency in off-pump coronary artery bypass grafting and total arterial grafting.

METHODS: We performed a prospective observational study to assess intraoperative graft patency in patients undergoing off-pump and on-pump coronary artery bypass grafting, who also underwent total arterial grafting. We used an intraoperative imaging system, SPY (Novadaq Technologies Inc), based on the fluorescent properties of indocyanine green dye.

RESULTS: We assessed the intraoperative graft patency of 533 conduits in 200 patients. The mean number of grafts was 2.7 per patient. Of these patients, 155 (78%) had off-pump coronary artery bypass grafting, and 45 (22%) had on-pump coronary artery bypass grafting. Overall, 161 (80%) had total arterial grafting, with composite arterial grafting performed in 120 (60%) patients. Fluorescence, confirming graft patency, was observed in all but 8 (1.5%) conduits in 8 (4%) patients, necessitating graft revision. Six (3.9%) and 2 (4.4%) of these patients, respectively, had off-pump coronary artery bypass grafting and on-pump coronary artery bypass grafting.

CONCLUSION: Intraoperative fluorescence imaging demonstrated a low (1.5%) but well-defined incidence of intraoperative graft failure, which affects around 4% of patients. This emphasizes the need for routine assessment of graft patency. Intraoperative fluorescence imaging permits detection and revision of failed grafts in the operating room. We found no difference in the incidence of failed grafts when comparing on-pump and off-pump total arterial grafting.




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