Intraoperative Invasive Coronary Angiography after Coronary Artery Bypass Grafting.

IF 1.3 4区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Thoracic and Cardiovascular Surgeon Pub Date : 2024-11-04 DOI:10.1055/s-0044-1791960
Tim Berger, Albi Fagu, Martin Czerny, Tau Hartikainen, Constantin Von Zur Mühlen, Sami Kueri, Matthias Eschenhagen, Maximilian Kreibich, Friedhelm Beyersdorf, Bartosz Rylski
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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.

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冠状动脉旁路移植术后的术中侵入性冠状动脉造影。
研究目的本研究旨在前瞻性地评估使用移动式血管造影 C 臂在冠状动脉搭桥术后进行术中有创冠状动脉造影(ICA)的可行性和安全性:方法:2020 年 8 月至 2021 年 12 月期间,18 名患者在冠状动脉搭桥术后接受术中 ICA。皮肤闭合后,由介入心脏病专家通过移动血管造影系统对所有已建立的搭桥移植物进行血管造影,包括血管造影。对移植物的通畅、狭窄和扭结情况进行了评估。对移植物进行了从极差(1)到极好(5)的等级评定。此外,还采用李克特(Likert)量表评估了 ICA 与血流测量法相比所产生的影响,量表范围从(I)更差到(V)更好:结果:与瞬时血流测量相比,38 个吻合口(93%)的 ICA 被认为更好(V),3 个吻合口(7%)的 ICA 被认为与之相当(III)。有 3 名患者(17%)的 ICA 影响了临床或手术决策。有一名患者开始接受为期 6 个月的双联抗血小板治疗,有两名患者(11%)需要重新进行胸廓切开术,对旁路移植进行修正,并因移植血管闭塞而进行额外的旁路移植手术。没有观察到脑栓塞和远端栓塞事件或入路血管并发症,也没有发生术后急性肾损伤:结论:冠状动脉搭桥术后术中血管造影是安全的。结论:冠状动脉旁路移植术后术中血管造影是安全的,使用移动血管造影设备对移植血管的通畅性和功能进行评估优于通过时间流量测量对相关患者造成的进一步后果。因此,它具有减少术后心肌损伤和提高存活率的潜力。
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来源期刊
CiteScore
3.40
自引率
6.70%
发文量
365
审稿时长
3 months
期刊介绍: The Thoracic and Cardiovascular Surgeon publishes articles of the highest standard from internationally recognized thoracic and cardiovascular surgeons, cardiologists, anesthesiologists, physiologists, and pathologists. This journal is an essential resource for anyone working in this field. Original articles, short communications, reviews and important meeting announcements keep you abreast of key clinical advances, as well as providing the theoretical background of cardiovascular and thoracic surgery. Case reports are published in our Open Access companion journal The Thoracic and Cardiovascular Surgeon Reports.
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