Arterial T-Graft in Coronary Surgery: Comparison of Selective Coronary Angiography and Multi-Slice Computed Tomography

Abstract

Background: The main aim of our study was to compare the results and value of angiography and multi-slice computed tomography (MSCT) after coronary artery bypass grafting using complex arterial conduit combinations. Methods: Twenty-six patients underwent coronary surgery. In all patients, we utilized a T-graft (free arterial graft centrally implanted into the left internal thoracic artery in situ). Postoperative coronary angiography and MSCT were carried out prior to discharge. The results were interpreted separately by two different investigators. Results: One hundred and thirteen distal anastomoses using 59 grafts for T-graft combinations were performed in 26 patients. A mean of 3.5 peripheral anastomoses was established per patient. Angiography showed a bypass graft patency rate of 94.6 % (56/59). In angiography, the patency rate of anastomoses was 96.5 % (109/113). All occlusions were identified in sequential anastomoses. The bypass patency rate measured by MSCT was 100 % and the patency rate of anastomoses 100 %. Based on these results, MSCT showed a sensitivity of 98.9 %. The specificity was 50.8 %, the positive predictive value was 94.6 % and the negative predictive value had a level of 99.9 %. Conclusion: MSCT is a simple, less invasive and useful method of monitoring results after coronary surgery including anastomosis and graft patency after complex arterial grafts. Its value may be restricted for sequential anastomoses and angiography should be preferentially used in these cases.

Key words

coronary bypass surgery - T‐graft - cardiac computed tomography - coronary angiography

References

• 1 Sabik 3rd J F. Comparison of saphenous vein and internal thoracic artery graft patency by coronary system.  Ann Thorac Surg. 2005;  79 544-551
• 2 Lytle B W, Blackstone E H, Loop F D. et al . Two internal thoracic artery grafts are better than one.  J Thorac Cardiovasc Surg. 1999;  117 855-872
• 3 Vicol C, Raab S, Beyer M. Die total arterielle Myokardrevaskularisation - Strategie, kurz- und mittelfristige Ergebnisse.  Z Kardiol. 2003;  92 222-228
• 4 Tector A J, Amundsen S, Schmahl T M. et al . Total revascularization with T grafts.  Ann Thorac Surg. 1994;  57 33-38
• 5 Muneretto C, Bisleri G, Negri A. et al . Total arterial myocardial revascularization with composite grafts improves results of coronary surgery in elderly: a prospective randomized comparison with conventional coronary artery bypass surgery.  Circul. 2003;  108 11-29
• 6 Wintersperger B J, Nikolaou K, Jakobs T F. et al . Cardiac multidetector-row computed tomography: initial experience using 16 detector row systems.  Crit Rev Comput Tomogr. 2003;  44 27-45
• 7 Ropers D, Ulzheimer S, Wenkel E. et al . Investigation of aortocoronary artery bypass grafts by multislice spiral computed tomography with electrocardiographic-gated image reconstruction.  Am J Cardiol. 2001;  88 792-795
• 8 Hong C, Becker C R, Huber A. et al . ECG-gated reconstructed multi-detector row CT coronary angiography: effect of varying trigger delay on image quality.  Radiology. 2001;  220 712-717
• 9 Engelmann M G, Knez A, von Smekal A. et al . Noninvasive coronary bypass graft imaging after multivessel revascularisation.  Int J Cardiol. 2000;  76 65-74
• 10 Yoo K J, Choi D, Choi B W. et al . The comparison of the graft patency after coronary artery bypass grafting using coronary angiography and multi-slice computed tomography.  Eur J Cardiothorac Surg. 2003;  24 86-91 91
• 11 Schlosser T, Konorza T, Hunold P. et al . Noninvasive visualization of coronary artery bypass grafts using 16-detector row computed tomography.  J Am Coll Cardiol. 2004;  44 1224
• 12 Achenbach S. Current and future status on cardiac computed tomography imaging for diagnosis and risk stratification.  J Nucl Cardiol. 2005;  12 703-713
• 13 Lu B, Dai R P, Jing B L. et al . Evaluation of coronary artery bypass graft patency using three-dimensional reconstruction and flow study on electron beam tomography.  J Comput Assist Tomogr. 2000;  24 663-667
• 14 Enzweiler C N, Kivelitz D E, Wiese T H. et al . Coronary artery bypass grafts: improved electron-beam tomography by prolonging breath holds with preoxygenation.  Radiology. 2000;  217 278-283
• 15 Ueyama K, Ohashi H, Tsutsumi Y. et al . Evaluation of coronary artery bypass grafts using helical scan computed tomography.  Catheter Cardiovasc Interv. 1999;  46 322-326
• 16 Vignaux O, Paul J F, Duboc D. Multislice CT and MRI of coronary artery disease: current and future role.  J Radiol. 2004;  85 1786-1795
• 17 Schroeder S, Kopp A F, Kuettner A. et al . Influence of heart rate on vessel visibility in noninvasive coronary angiography using new multislice computed tomography: experience in 94 patients.  Clin Imaging. 2002;  26 106-111
• 18 Baumgartner F, Brundage B, Bleiweis M. et al . Feasibility of ultrafast computed tomography in the early evaluation of coronary bypass patency.  Am J Card Imaging. 1996;  10 170-174