Intraoperative angiography to assess graft patency after minimally invasive coronary bypass

Background. Intraoperative angiography was performed to confirm graft paten cy immediately after minimally invasive coronary bypass operations. Methods. In 26 patients who had internal mammary artery grafting, intraoper ative coronary angiography was performed with a portable digital fluoroscop e. Results. High-resolution angiograms were obtained in all cases. Angiography documented vasospasm of the graft or native vessel in 9 patients (graft in 3, native in 2, graft and native in 4 others), which responded promptly to intracoronary vasodilators in all. Angiography identified technically unsu spected and clinically silent fixed stenoses (>50%) in 11 patients, attribu table to graft kinking in 2, anastomotic obstruction in 6 (total occlusion in 4), and stenosis of the left anterior descending artery just distal to t he anastomosis in three cases (total occlusion in one). In 9 of 11 patients , fixed stenoses were sufficiently severe to warrant intraoperative interve ntion by surgical revision (n = 5) or angioplasty via the graft (n = 4). Conclusions. Intraoperative angiography after minimally invasive coronary a rtery bypass operations can immediately identify dynamic and fixed obstruct ions and facilitate their prompt treatment, thereby ensuring that each pati ent leaves the operating room with an optimal surgical result. (C) 1998 by The Society of Thoracic Surgeons.