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CLINICAL RESEARCH: INTERVENTIONAL CARDIOLOGY

Routine Intraoperative Completion Angiography After Coronary Artery Bypass Grafting and 1-Stop Hybrid Revascularization

Results From a Fully Integrated Hybrid Catheterization Laboratory/Operating Room

Vanderbilt Heart and Vascular Institute, Nashville, Tennessee

Manuscript received June 16, 2008; revised manuscript received October 9, 2008, accepted October 14, 2008.

^_* Reprint requests and correspondence: Dr. John G. Byrne, Vanderbilt Heart and Vascular Institute, Department of Cardiac Surgery, 1215 21st Avenue South, MCE–North Tower–Suite 5025, Nashville, Tennessee 37232-8802 (Email: john.byrne{at}vanderbilt.edu).

Objectives: This study sought to report our experience with a routine completion angiogram after coronary artery bypass surgery (CABG) and simultaneous (1-stop) percutaneous coronary intervention (PCI) at the time of CABG performed in the hybrid catheterization laboratory/operating room.

Background: The value of a routine completion angiogram after CABG and 1-stop hybrid CABG/PCI remains unresolved.

Methods: Between April 2005 and July 2007, 366 consecutive patients underwent CABG surgery, with (n = 112) or without (n = 254) concomitant 1-stop PCI (hybrid), all with completion angiography before chest closure. Among the 112 1-stop hybrid CABG/PCI patients, 67 (60%) underwent a planned hybrid procedure based on pre-operative assessment, whereas 45 (40%) underwent open-chest PCI (unplanned hybrid) based on intraoperative findings.

Results: Among the 796 CABG grafts (345 left internal mammary artery, 12 right internal mammary artery/radial, and 439 veins), 97 (12%) angiographic defects were identified. Defects were repaired with either a minor adjustment of the graft (n = 22, 2.8%), with intraoperative open-chest PCI (unplanned hybrid, n = 48, 6%) or with traditional surgical revision (n = 27, 3.4%). Hybrid patients had clinical outcomes similar to standard CABG patients.

Conclusions: Routine completion angiography detected 12% of grafts with important angiographic defects. One-stop hybrid coronary revascularization is reasonable, safe, and feasible. Combining the tools of the catheterization laboratory and operating room greatly enhances the options available to the surgeon and cardiologist for patients with complex coronary artery disease.

Key Words: hybrid coronary revascularization • coronary angiography • percutaneous coronary intervention • coronary artery bypass surgery

Abbreviations and Acronyms   BMS = bare-metal stent(s)   CABG = coronary artery bypass grafting   DES = drug-eluting stent(s)   LAD = left anterior descending artery   LIMA = left internal mammary artery   OR = operating room   PCI = percutaneous coronary intervention   SVG = saphenous vein graft

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