The Results of Intraoperative Bypass Angiography in Surgical Myocardial Revascularization: Three Year Experience of One Centre

Vladimir V. Losev, Leo A. Bockeria, Manolis G. Pursanov, Andrey V. Sobolev, Pavel V. Vartanov, Aslan V. Karaev

A.N. Bakoulev Scientific Center for Cardiovascular Surgery, Moscow, Russia

Date, time and location: 2018.05.26 08:30, Exhibition area, 1st Floor. Zone – C

Abstract

Objective. To demonstrate possibilities and potential of intraoperative bypass angiography (BPA) in improvement of surgical myocardial revascularization.

Materials and methods. From April 2015 to December 2017 in cardiovascular institute of A.N. Bakoulev Scientific Centre for Cardiovascular Surgery 2142 patient has underwent isolated coronary artery bypass graft surgery (CABG). Median age was 61,1+20,2. Gander deviation: 1340 (62,6%) patients were male and 798 (37,4%) – female.

In 1510 (70%) patient’s operation was performed on pump, in 632 (29,5 %) – of pump.

In total 4931 graft were applied in 2142 patients (median 2,3+0,6 grafts for 1 patient). For revascularization of left anterior descending (LAD) and diagonal branches (D) internal mammary grafts were applied in 81,6% and 18,4% respectively. For grafting of obtuse marginal branche (OM) and intermedia artery, autoveins were used in 85,6%, and for grafting of the right coronary artery (RCA) – in 99,1%. In 0,8% sequential grafts were applied.

Results.Of total number of graft in 429 (8,7 %) we registered dysfunctions, which required intraoperative corrections. Dysfunctions of vein graft were manly registered in OM (197 (45,9 %)) and in RCA (69 (16,0 %)). Lesions on internal mammary graft were registered in 118 (27,5%) cases of revascularised LAD. Registered dysfunctions were systemised and described as: hemodynamically significant stenosis (146 (34,1%)), graft kinking (138 (32,2%)), occlusions (113 (26,3 %)), free flow of contrast into the pericardial space (13 (3,0 %)), graft dissection (12 (2,8%)) and drainage tube compression of graft or native coronary artery.

Conclusion. IBA helps to improve CABG results by detecting various causes of dysfunction and their intraoperative correction.