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Steve K. Singh
Nimesh D. Desai
Genta Chikazawa
Hiroshi Tsuneyoshi
Fuad Moussa
Gideon N. Cohen
George T. Christakis
Stephen E. Fremes
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J Thorac Cardiovasc Surg 2010;139:294-301
© 2010 The American Association for Thoracic Surgery

Acquired Cardiovascular Disease

The Graft Imaging to Improve Patency (GRIIP) clinical trial results

Steve K. Singh, MD, MSca,*, Nimesh D. Desai, MD, PhDa, Genta Chikazawa, MD, PhDa, Hiroshi Tsuneyoshi, MD, PhDa, Jessica Vincent, BSca, Brandon M. Zagorski, MScc, Visal Pen, MDb, Fuad Moussa, MD, MSca, Gideon N. Cohen, MD, PhDa, George T. Christakis, MD, MSca, Stephen E. Fremes, MD, MSca,c

a Division of Cardiac and Vascular Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
b Division of Medical Imaging, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
c Institute for Clinical Evaluative Science, Toronto, Ontario, Canada

Read at the Eighty-ninth Annual Meeting of The American Association for Thoracic Surgery (C. Walton Lillehei Resident Forum), Boston, Massachusetts, May 9–13, 2009.

Received for publication May 8, 2009; revisions received September 8, 2009; accepted for publication September 28, 2009.

* Address for reprints: Steve K. Singh, MD, MSc, c/o Stephen E. Fremes, MD, MSc, 2075 Bayview Ave, Suite H410, Toronto, Ontario, Canada M4 N 3M5. (Email: stephen.fremes{at}sunnybrook.ca).

Objective: This trial aimed to determine whether intraoperative graft assessment with criteria for graft revision would decrease the proportion of patients with 1 or more graft occlusions or stenoses or major adverse cardiac events 1 year after coronary artery bypass grafting.

Methods: A single-center, randomized, single-blinded, controlled clinical trial was designed. Patients were randomized to either of 2 groups: intraoperative graft patency assessment using indocyanine-green fluorescent angiography and transit-time flowmetry, with graft revision according to a priori criteria (imaging group), or standard intraoperative management (control group). Patients underwent follow-up angiography at 1 year.

Results: Between September 2005 and August 2008, 156 patients undergoing isolated coronary bypass grafting were enrolled (imaging, n = 78; control, n = 78). Demographic and angiographic characteristics were similar between groups. Operative, crossclamp, and cardiopulmonary bypass times were all nonsignificantly longer in the imaging arm. The number of grafts per patients was similar (imaging, 3.0 ± 0.7; control, 3.0 ± 0.7). The frequency of major adverse cardiac events (death, myocardial infarction, repeat revascularization) was not different between groups at 1 year postoperatively (imaging, 7.7%; control, 7.7%). One-year angiography was performed in 107 patients (imaging, 55 patients/160 grafts; control, 52 patients/152 grafts). The proportion of patients with 1 graft occlusion or more was comparable in the imaging (30.9%) and control (28.9%) groups (relative risk [95% confidence interval], 1.1 [0.6–1.9]; P = .82), as were other graft patency end points. The incidence of saphenous vein graft occlusion was high in both groups.

Conclusions: Routine intraoperative graft assessment is safe but does not lead to a marked reduction in graft occlusion 1-year after bypass grafting. The incidence of saphenous vein graft failure remains high despite contemporary practice and routine intraoperative graft surveillance.

Abbreviations and Acronyms CABG = coronary artery bypass graft; CPB = cardiopulmonary bypass; GRIIP trial = Graft Imaging to Improve Patency trial; ICG = indocyanine green; MACE = major adverse clinical event; TTF = transit-time ultrasound flowmetry




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S. K. Singh and K. A. Ihnken
Intraoperative Fluorescence Angiography to Identify and Confirm Repair of Intramyocardial Left Anterior Descending Coronary Artery Aneurysm
Ann. Thorac. Surg., October 1, 2010; 90(4): e62 - e62.
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