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J Thorac Cardiovasc Surg 2003;126:634-637
© 2003 The American Association for Thoracic Surgery

Editorial

Intraoperative assessment of coronary artery bypass grafts

^a the University of Cincinnati, Department of Surgery, Cincinnati, Ohio, USA
^b University of Leipzig, Clinic for Heart Surgery, Leipzig, Germany

Received for publication December 20, 2002; accepted for publication March 4, 2003.

^* Address for reprints: Randall K. Wolf, MD, University of Cincinnati, Director, Institute for Surgical Innovation, 231 Albert B. Sabin Way, M.L. 0558, Cincinnati, OH 45267 USA

The first 300 words of the full text of this article appear below.

Dr Wolf

We make the path by walking...

It is no exaggeration to predict that the acceptance of alternate coronary artery bypass grafting (CABG) techniques, such as off-pump coronary artery bypass, minimally invasive direct coronary artery bypass (MIDCABG), and endoscopic CABG, will ultimately depend on graft patency in comparison with open, standard, on-pump techniques. Graft patency will also be the final determinant of success for evolving anastomotic devices in CABG. Results of early, but not intraoperative, angiography after conventional CABG reveal that 45% to 100% of the patients in the study (operated) had follow-up angiography but document a patency rate for left internal thoracic artery (LITA) to left anterior descending artery (LAD) grafts of 94% to 98%.¹ It is known that LITA graft patency changes little after the initial period. This suggests that long-term arterial graft patency is excellent and that the majority of arterial graft failures occur early and are most likely caused by technical problems. It follows that graft patency could be improved if technical problems are identified early. Logically, the arterial conduit and anastomosis should be assessed immediately. This is best accomplished in the operating suite at a time when problems can be readily addressed by the surgical team. There are several technologies, some accepted and some evolving, that can be used in intraoperative coronary graft assessment. These are summarized in Table 1. ²

Despite encouraging technologic advances in noninvasive scanning and in physiologic measures of blood flow in the coronary tree, coronary angiography has remained the gold standard for both the cardiologist and the surgeon both preoperatively and postoperatively. Intraoperative coronary angiography can be performed with a fixed unit installed in the operating suite or with portable units. The disadvantage of portable units is a possible lack of definition . . . [Full Text of this Article]