Multidetector CT angiography as a noninvasive tool to assess graft patency of surgically reconstructed diffusely diseased coronary arteries

Abstract

Recent refinements in percutaneous techniques have resulted in an increase in the numbers of patients with diffuse coronary artery disease who are referred to cardiac surgeons. Long reconstruction of the diffusely diseased vessel may be a useful surgical option. Close and careful follow up of such subgroup of patients is mandatory. Invasive graft angiography serves as the diagnostic standard for follow up of graft patency for such extensive procedure; however, because of the risks, discomfort, and costs of a hospital stay, a noninvasive diagnostic tool is desirable. MDCT angiography is a noninvasive and safe alternative to assess graft patency in patients after CABG with reconstructed diffusely diseased vessels. Between July 2007 and September 2011, 62 patients with the diffusely diseased LAD underwent a long-segmental reconstruction procedure with a LITA graft. The diffusely diseased LAD was extensively incised, additional endarterectomy was performed if necessary, and then the LAD was reconstructed with an ITA graft in a long on-lay fashion. Postoperative MDCT angiography as a non invasive single tool was performed in 25 asymptomatic patients to assess graft patency with at least 6 months postoperative period. The cohort consisted of 23 men (92%) and 2 women (8%), and the mean age was 58.5 ± 9.2 years. The mean length of the arteriotomy incision was 3.5 ± 1.2 cm (range, 2.5 –5 cm). Endarterectomy was performed in 3 patients (12%). perioperative MI was recorded among 1 patient (4%). ITA to LAD graft was patent in all patients (100%) including that patient who had perioperative MI. Other incidental findings were found in venous grafts. Extensive reconstruction of the diffusely diseased LAD using an ITA graft could be performed safely with very encouraging results. MDCT angiography is an excellent non invasive tool not only to evaluate graft patency in the reconstructed LAD but also to detect other findings in asymptomatic patients with diffuse coronary artery disease for better and more close follow up.