A Prospective Comparison of Doppler Echocardiography and
Postoperative Angiography in the Assessment of Left Internal Thoracic
Artery Graft in 72 Patients Submitted to Minimally Invasive Direct
Coronary Artery Bypass
(#2001-6934 ... June 27, 2001)
Luiz Augusto Ferreira Lisboa, Luís Alberto Dallan, Luiz
Francisco Poli de Figueiredo, Lazslo Molnar, Eulógio Martinez
Filho, José Antonio Francchini Ramires, Sérgio Almeida de
Oliveira
Division of Thoracic and Cardiovascular Surgery, Heart Institute,
InCor, University of São Paulo Medical School, São Paulo,
SP, Brazil
Presented at the Fourth Annual Scientific Meeting of the International
Society for Minimally Invasive Cardiac Surgery, June 27-30, 2001,
Munich, Germany.
ABSTRACT
Background: Concerns have been raised regarding the accuracy of
the left internal thoracic artery (LITA) anastomosis performed during
minimally invasive direct coronary artery bypass (MIDCAB). In a
prospective study, we tested the hypothesis that transthoracic Doppler
echocardiography is an adequate technique to determine LITA patency when
compared to "gold standard" postoperative angiography.
Methods: Seventy-two consecutive patients with single left
anterior descending (LAD) coronary artery stenosis were submitted to
MIDCAB performed on a beating heart using the LITA. All patients
underwent transthoracic Doppler Echocardiography and angiography before
discharge. LITA was considered patent when diastolic fraction (DF) of
time-velocity integral was equal or greater than 0.5. FitzGibbon grading
system was used to evaluate LITA patency by angiography (A=excellent;
B=stenosis reducing caliber of anastomosis or trunk to < 50% of grafted
coronary artery; O=occlusion).
Results: Angiography showed that LITA was patent in 70 (97.2%)
patients, 69 of them been graded A. Adequate image and flow signal of
the LITA was achieved in 65 (90.3%) patients, been considered patent in
61 (93.8%) of them. Comparison between echocardiography and angiography
in these 65 patients showed a specificity of 96.8% and a sensitivity of
50%. In 7 (9.7%) patients in whom no adequate echocardiography signal
was obtained, the LITA graft was normal in six and occluded in one.
Conclusions: For patients whose LITA graft can be imaged,
transthoracic Doppler echocardiography is highly specific and is a
valuable method for noninvasive evaluation of LITA graft patency after
MIDCAB.
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