Revival of Endovascular Visual Assessment of Anastomotic Patency in Coronary Artery Bypass Graft Surgery

Background : Coronary artery bypass graft surgery (CABG) is considered the most performed cardiac surgery nowadays. The outcome of CABG surgery has been linked to several aspects. Above all is graft patency which is a crucial element contributing to success of the surgery. Early graft failure following CABG has been recorded in up to 12% of grafts (left IMA 7%; saphenous vein graft 8%). Objectives: The aim of the present study was to determine the efficacy and feasibility of the endovascular visualization to detect anastomotic errors. Patients and methods: The study included 40 patients who presented with CAD and were candidates for coronary artery bypass grafting (CABG). All anastomoses were assessed using 1.9 mm telescope and endovascular visualisation score was recorded followed by routine assessment of grafts quality using transient time flow meter. Results: In this prospective cross-sectional study, we included a total of forty patients who underwent CABG which enabled intraoperative assessment of the quality of 70 venous grafts. There is a statistically significant correlation between the endovascular visual score and the mean flow across the OM and RCA grafts. For the Diagonal grafts , the correlation was less evident due to the small sample number. Conclusion: Coronary angioscopy is a simple and safe procedure and provides clinically relevant information. It provides immediate control of anastomotic quality and it can assist in the assessment of the native coronary artery. Together with transient time flowmeter, it provides a new alternative for the quality control of CABG surgery.