Abstract
Objective – to demonstrate the possibilities and practical potential of intraoperative coronary bypass angiography (ICBA) in the direct improvement of surgical myocardial revascularization.
Material and methods. Starting from 2009, at the initiative of academician L.A. Bockeria, ICBA performed routinely in all patients after surgical myocardial revascularization in Bakoulev National Medical Research Center for Cardiovascular Surgery. We present a detailed statistical analysis of ICBA performed in 1000 patients from January 2015 to January 2018. Median age was 57.5±22.4. Gender deviation: 643 (64.3%) patients were male and 357 (35.7%) – female.
In 984 (98.4%) patient's operation was performed on pump, in 16 (1.6%) – of pump.
In total 2322 graft was applied in 1000 patients (median 2.3 ± 0.6 grafts for one patient). For revascularization of left anterior descending (LAD) and diagonal branches internal mammary grafts were applied in 81.6 and 18.4% respectively. For grafting of the obtuse marginal (OM) branch and a. intermedia, veins used in 85.6%, and for grafting of the right coronary artery (RCA) – in 99.1%. In 4% sequential grafts were applied.
Results. Of 2322 grafts in 506 (21.8%) we registered dysfunctions, which required intraoperative corrections. Dysfunctions of vein graft were manly registered in LAD (192; 37.9%) and in OM (156; 30.8%). Registered dysfunctions were systemised and described as: hemodynamically significant stenosis (219; 43.3%), graft kinking (86; 16.9%), occlusions (105; 20.7%), contrast outflow into the pericardial space (14; 2.7%), graft dissection (16; 3%) and drainage tube compression of graft or native coronary artery. In further statistic analysis we have determined statistically significant relevance between left ventricle ejection fraction and number of distal anastomosis (KW-H (3; 594) = 16.3114; p = 0.0010; F (3; 541) = 4.5168; p = 0.0039). Also, we have determined that regardless of conduit material and grafted artery number of dysfunctions increased relevant to an overall number of distal anastomosis per patient (p = 0.000008). On the other hand, examining how mature age affects graft disfucntions occurance frequency we registewred no significant relevance (KW-H (3; 599) = 0.804; p = 0.8485; F (3; 595) = 0.6763; p = 0.5668). Intraoperative surgical revisions and manipulations were carried out in 324 (64%) of 506 dysfunctional coronary grafts. At the endpoint of surgery 2140 (92.2%) of 2322 coronary grafts were stated as fully functional.
Conclusion. ICBA helps to improve CABG results by detecting various causes of dysfunction and their intraoperative correction.
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About the authors
- Leo A. Bockeria, Academician of RAS and RAMS, Director, orcid.org/0000-0002-6180-2619
- Karen V. Petrosyan, Cand. Med. Sc., Head of Department, orcid.org/0000-0002-3370-0295
