INTRAOPERATIVE ANGIOSCOPY FOR CORONARY-BYPASS SURGERY

Despite advances in coronary artery surgery, technical abnormalities r emain a significant cause of early graft closure. The development of s mall fiberoptic angioscopes now allows direct intravascular magnified examination. Seventy-five distal anastomoses and vein grafts, and five selected coronary arteries were examined with 0.8- to 2.5-mm diameter angioscopes introduced through the proximal vein graft while irrigati ng with dear cardioplegia. Angioscopic findings were correlated with a ngiographic data, vessel morphology, graft flow, and postoperative cou rse. Satisfactory images were obtained in 72 of 75 anastomotic inspect ions. Each examination took less than 2 minutes and required less than 100 cc of flush. Angioscopic abnormalities that did not require revis ion were noted in 17 of 72 anastomoses; intimal flaps in 9, thrombus o n posterior wall plaque in 4, intimal irregularities in 4, buckling of posterior wall in 3, and valve near anastomoses in 1. No outflow obst ruction nor misplaced sutures were noted. Average flow rate through th e grafts with anastomotic angioscopic abnormalities was 33 cc/min vers us 40 cc/min in the remaining grafts. However, regression analysis rev ealed that low-graft flow was correlated with vessel size and runoff b ut was not with angioscopic findings. Intracoronary angioscopy reveale d discrepancy with angiographic findings in 4 of the 5 examinations. N o complications occurred as a result of angioscopy. No graft closure h as occurred during early follow-up. Intraoperative angioscopy can be d one with minimal alteration of the usual routine. The 24% occurrence o f minor angioscopic abnormalities did not appear to compromise graft f low or early patency.