Optical coherence tomography of coronary grafts

Abstract

Background. Coronary artery bypass graft surgery is the most common cardiac surgery in the world. Graft failure is a complex multifactorial process that occurs in a significant part of all grafts.Aim. To identify predictors of early coronary bypass failure using optical coherence tomography.Methods. A prospective observational study included 10 patients with multivessel coronary artery disease who underwent coronary artery bypass grafting. After surgical myocardial revascularization, the patients underwent coronary angiography with optical coherence tomography (OCT) of arterial and venous grafts, including the distal anastomosis and conjugate segment of the target coronary artery. Endothelial damage; the presence of severe tortuosity, stenosis, spasm and parietal thrombi; the ratio of the diameters of the conduit and the native coronary artery was assessed.Results. A control study revealed several findings. In one case, the left internal mammary artery was occluded, which required stenting of the left anterior descending artery. In one patient, a dissection of the left internal mammary artery anastomosis was revealed, while a double lumen with the formation of a false channel was revealed on the OCT. In one case, stenosis of a saphenous vein graft on the right coronary artery was determined (53.1% by area). In three cases, a pronounced recalibration of the diameters of the saphenous vein graft and the target coronary artery with more than two times the ratio was revealed, and in one case, the diameter of the target artery was less than 2 mm.Conclusion. OCT is an effective method for visualizing morphological changes not only in coronary arteries, but also in coronary bypass grafts, which may be associated with early graft failure.