Intraoperative Invasive Coronary Angiography after Coronary Artery Bypass Grafting

Abstract

Objective The aim of this study was to prospectively evaluate the feasibility and safety of intraoperative invasive coronary angiography (ICA) following coronary artery bypass grafting using a mobile angiography C-arm.

Methods Between August 2020 and December 2021, 18 patients were enrolled for intraoperative ICA following coronary artery bypass grafting. After skin closure, ICA was performed including angiography of all established bypass grafts via a mobile angiography system by an interventional cardiologist. Data on graft patency, stenosis, and kinking were assessed. Grafts were rated on an ordinal scale ranging from very poor (1) to excellent (5). Furthermore, the impact of ICA compared with flow measurement was assessed using the ordinal Likert scale ranging from (I) worse to (V) much better.

Results The ICA was considered better (V) compared with transient flow measurement in 38 (93%) and comparable (III) in 3 (7%) distal anastomoses. ICA impacted clinical or surgical decision-making in three patients (17%). In one patient, dual antiplatelet therapy for 6 months was initiated and rethoracotomy was needed in two (11%) patients with bypass graft revision and additional bypass grafting for graft occlusion. There were no cerebral and distal embolic events or access vessel complications observed and no postoperative acute kidney injury occurred.

Conclusion Intraoperative angiography after coronary bypass grafting is safe. Using a mobile angiographic device, graft patency, and function assessment was superior to transit time flow measurement leading to further consequences in a relevant number of patients. Therefore, it has the potential to reduce postoperative myocardial injury and improve survival.

Keywords

intraoperative ICA - quality control after CABG - CABG assessment

Data Availability Statement

The data underlying this article cannot be shared publicly due to ethical reasons. The data will be shared on reasonable request to the corresponding author.

Authors' Contribution

T.B.: conceptualization, formal analysis, methodology, and writing—original draft. M.C. and C.v.Z.M.: supervision and writing—review and editing., investigation; A.F. and T.H.: writing—review and editing. S.K. and M.E.: visualization and writing—review and editing. M.K.: conceptualization, visualization, and writing—review and editing. B.R.: project administration, conceptualization, methodology, investigation, supervision, validation, and writing—original draft. F.B.: conceptualization, supervision, writing revision, and editing. All authors contributed to the article and approved the submitted version.

Publication History

Received: 11 April 2024

Accepted: 27 September 2024

Article published online:
04 November 2024

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