Objectives: The techniques of performing coronary
revascularization without cardiopulmonary bypass are rapidly evolving.
However, concern remains regarding the accuracy of coronary artery
anastomoses performed on the beating heart. This report reviews the use
of intraoperative angiography in the critical appraisal of“
off-pump” coronary artery bypass graft (CABG) surgery.
Patients: Intraoperative angiography was performed in 24
consecutive patients undergoing CABG surgery without cardiopulmonary
bypass. In all, 24 left internal mammary artery (LIMA) grafts and 18
saphenous vein bypass grafts were assessed for patency, anastomosis
quality, distal and proximal runoff, and correct placement.
Results: All of the saphenous vein-to-coronary artery
anastomoses were widely patent, although two patients (8%) required
revision of their LIMA grafts on the basis of angiographic
Conclusion: Intraoperative angiography
permits the surgeon to immediately appraise the CABG and to revise, if
necessary, any graft abnormality, thus potentially eliminating the need
for early repeated surgery. The practice of routine intraoperative
angiography is likely to improve the outcome of CABG surgery on the
Abbreviations: CABG = coronary artery bypass
graft; LAD = left anterior descending coronary artery; LIMA = left
internal mammary artery; MIDCABG = minimally invasive direct coronary
artery bypass graft; SVG = saphenous vein grafts