Intraoperative angiography to assess graft patency after minimally invasive coronary bypass

Background. Intraoperative angiography was performed to confirm graft patency immediately after minimally invasive coronary bypass operations. Methods. In 26 patients who had internal mammary artery grafting, intraoperative coronary angiography was performed with a portable digital fluoroscope. 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 unsuspected and clinically silent fixed stenoses (>50%) in 11 patients, attributable to graft kinking in 2, anastomotic obstruction in 6 (total occlusion in 4), and stenosis of the left anterior descending artery just distal to the anastomosis in three cases (total occlusion in one). In 9 of 11 patients, fixed stenoses were sufficiently severe to warrant intraoperative intervention by surgical revision (n = 5) or angioplasty via the graft (n = 4). Conclusions. Intraoperative angiography after minimally invasive coronary artery bypass operations can immediately identify dynamic and fixed obstructions and facilitate their prompt treatment, thereby ensuring that each patient leaves the operating room with an optimal surgical result.