Abstract 2117: Intra-Operative Completion Angiography After CABG with Immediate Percutaneous or Surgical Revision of Defects: One Year Experience from the Vanderbilt Hybrid Catheterization and Operating Room
Background: Coronary bypass surgery (CABG) does not traditionally employ immediate completion angiography to assess procedural success. However, early (1 year) graft failure is reported as high as 30% (JAMA Nov 2005) and may relate to technical errors. We hypothesize that intra-operative assessment of graft integrity by angiography identifies graft defects and guides appropriate percutaneous or surgical revisions without increasing immediate adverse outcomes.
Methods and Results: We have developed one of the first hybrid catheterization and operation rooms in the United States. Between April 2005 and April 2006, 203 consecutive patients (age 63±16 years, 126 male, 39 female) underwent CABG with intraoperative completion angiography immediately after cessation of cardiopulmonary bypass. Of 436 grafts, 72 angiographic defects were detected in 69 grafts (17% of total grafts). There were 48/436 (11%) conduit defects, 13/436 (3%) anastomotic defects, and 11/436 (3%) target vessel errors. Of 72 defects, 25/72 (35%) defects required minor revision. 47/72 (65%) defects required surgical (18/47, 38%) or percutaneous (29/47, 62%) revision. Intra-operative angiography added an average 20±12 minutes to the surgery and 112±56 ml contrast (Visipaque). There was a clinically mild but statistically significant increase in serum creatinine at 48 hours (1.17 vs. 1.04, p=0.045). Renal function at 24 and 48 hours after procedure did not vary significantly between patients who did and did not have revisions. There were no significant differences in cardiopulmonary bypass time, aortic cross clamp time, or length of hospital stay for patients who underwent revision compared to those who did not. Renal function, bleeding complications, and transfusions were similar in patients with percutaneous vs. surgical revision.
Conclusions: Intraoperative graft angiography performed at the time of CABG identifies graft defects, allowing for immediate surgical or percutaneous revision. Long-term study is in progress to assess whether intra-operative completion angiography decreases the rate of early graft failure.