Document Detail

Routine intraoperative completion angiography after coronary artery bypass grafting and 1-stop hybrid revascularization results from a fully integrated hybrid catheterization laboratory/operating room.
MedLine Citation:
PMID:  19147039     Owner:  NLM     Status:  MEDLINE    
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.
David X Zhao; Marzia Leacche; Jorge M Balaguer; Konstantinos D Boudoulas; Julie A Damp; James P Greelish; John G Byrne; ; Rashid M Ahmad; Stephen K Ball; John H Cleator; Robert J Deegan; Susan S Eagle; Pete P Fong; Joseph L Fredi; Steven J Hoff; Henry S Jennings; John A McPherson; Robert N Piana; Mias Pretorius; Mark A Robbins; David A Slosky; Annemarie Thompson
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Publication Detail:
Type:  Comparative Study; Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Journal of the American College of Cardiology     Volume:  53     ISSN:  1558-3597     ISO Abbreviation:  J. Am. Coll. Cardiol.     Publication Date:  2009 Jan 
Date Detail:
Created Date:  2009-01-16     Completed Date:  2009-02-04     Revised Date:  2009-12-08    
Medline Journal Info:
Nlm Unique ID:  8301365     Medline TA:  J Am Coll Cardiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  232-41     Citation Subset:  AIM; IM    
Vanderbilt Heart and Vascular Institute, Nashville, Tennessee, USA.
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MeSH Terms
Aged, 80 and over
Angioplasty, Transluminal, Percutaneous Coronary / adverse effects,  methods*
Cohort Studies
Combined Modality Therapy
Coronary Angiography / methods*
Coronary Artery Bypass / adverse effects,  methods*
Coronary Disease / radiography*,  surgery*,  therapy
Follow-Up Studies
Heart Catheterization / methods
Intraoperative Care / methods
Middle Aged
Operating Rooms*
Radiography, Interventional
Retrospective Studies
Risk Assessment
Sensitivity and Specificity
Statistics, Nonparametric
Treatment Outcome
Vascular Patency
Comment In:
J Am Coll Cardiol. 2009 Dec 8;54(24):2337; author reply 2337-8   [PMID:  19958973 ]
J Am Coll Cardiol. 2009 Jan 20;53(3):242-3   [PMID:  19147040 ]

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