Abstract 18587: Acute Flow Physiology in Arterial in-situ Grafts at CABG
Background: There is advocacy for multi-arterial grafting as a new CABG standard of care, based on assumed 10-20 yr graft patency and documented survival benefit. This standard emphasizes the technical and functional quality imperative of each graft. Real-time data on the acute flow physiology of the Arterial in-situ Graft (AisG) and the Target Vessel Epicardial Coronary Artery (TVECA), including competitive flow (CF), is an unmet need in CABG surgery.
Hypothesis: Acute AisG flow dynamics will demonstrate minimal CF in TVECAs with > 70% stenoses.
Population: 100 consecutive patients; off-pump (OPCAB); single expert CABG surgeon/single institution. Closed care delivery system, with routine mean clinical follow-up of 12 months.
Methods: Near-infrared fluorescence angiography (NIRFA) with Complex Angiography and Perfusion Analysis (CAPA) was used on all grafts/patient as technical quality standard of care, and to study coronary flow physiology in vivo. NIRFA images the graft + TVECA; CAPA quantifies regional myocardial perfusion (RMP) changes from the new graft flow. In this analysis we studied AisGs to the Left Anterior Descending TVECA (N = 100); all proximal native stenoses were > 70% (preop cine); all anastomoses met surgical technical and clinical quality criteria.
Results: 100 grafts were patent by NIRFA, without clinical technical errors. Physiologically, 22% of grafts had objective imaging evidence of CF: 1) flow reversal in early systole, 2) decreased flow throughout diastole, and 3) > 3 consecutive cardiac cycles (FIGURE). CF was linked to the change in RMP. No patient returned for angiography during the follow-up interval.
Conclusions: By intraoperative physiologic flow imaging, CF between the AisG and the TVECA (> 70% stenosis) is much more frequent (22%) that previously assumed, and linked to RMP changes, despite widely patent grafts by NIRFA. There remains much to learn about the acute flow physiology of AisGs in this new CABG standard of care era.
Author Disclosures: A.N. Buch: None. C. Chen: None. J.A. Babb: None. T. Ferguson: None.
- © 2016 by American Heart Association, Inc.