INTRAOPERATIVE ANGIOGRAPHY DURING MINIMALLY INVASIVE DIRECT CORONARY-ARTERY BYPASS OPERATIONS

Background. The technical demands of beating heart operations raise co ncerns about anastomotic patency. This feasibility study tested the us efulness of intraoperative angiography during minimally invasive direc t coronary artery bypass grafting (MIDCABG). Methods. Ten patients und erwent intraoperative angiography of the internal thoracic artery (ITA ) after MIDCABG. Minimally invasive direct coronary artery bypass graf ting was performed on a beating heart through the fourth or fifth inte rcostal space. Angiography was performed through the right or left fem oral artery with a 7F introducer system placed before the operation. V iews were obtained in the right and left anterior oblique and straight anterior projections. Results. There were no deaths or intraoperative morbidities related to MIDCABG or angiography. Seven patients demonst rated widely patent MIDCABG anastomoses with obliteration of all inter costals, widely patent ITA pedicles, good distal runoff, and placement of the ITA into the proper native coronary artery. Two patients had r evisions of their ITA pedicles, which on repeated angiography showed c orrection. One patient's procedure was converted to a sternotomy becau se of poor distal runoff and haziness at the level of the MIDCABG anas tomosis. Conclusions. This feasibility study demonstrates the utility of intraoperative ITA angiography in identifying problems after MIDCAB G. Intraoperative angiography may facilitate MIDCABG by documenting pr oper placement of conduits, obliteration of intercostal vessels, and p atency of the MIDCABG anastomosis and ITA pedicle. (C) 1997 by The Soc iety of Thoracic Surgeons.