Coronary graft patency after perioperative myocardial infarction: a study with multislice computed tomography

Abstract

A total of 55 consecutive patients who experienced perioperative myocardial infarction (MI) after coronary artery bypass grafting were studied using multislice computed tomography (MSCT) angiography to evaluate for graft patency. The MSCT detected acute graft occlusion in 23% grafts. Of the 55 patients, 40% patients had occluded grafts and perioperative MI in the area of the grafted vessels; remaining 60% had patent grafts with infarction in the area of the grafted vessels. Compared with the patients with patent grafts, those with occluded grafts had a higher blood sugar level. In addition, graft occlusion was higher in grafts with severe distal disease. Among the patients with patent grafts, luminal stenosis of the native vessels supplying the infarcted myocardium was higher than that in the native vessels supplying the non-infarcted myocardium. In conclusion, MSCT is feasible for the assessment of graft patency in the setting of perioperative MI. Graft occlusion is detected in less than half of the cases and usually occurs in the grafts with severe distal involvement and the patients with uncontrolled hyperglycemia. In patients with patent grafts, the severity of luminal stenosis of the native grafted vessel is the main predisposing factor for perioperative MI.

Off-Pump Coronary Artery Bypass Grafting with Mini-Sternotomy in the Treatment of Triple-Vessel Coronary Artery Disease

“…21) In the current study, no death or stroke occurred in the patients receiving TM-OPCAB within 30 days after surgery, and only one patient experienced perioperative myocardial infarction. In contrast to the rates of in-hospital mortality (0.5%-2%) and perioperative myocardial infarction (4%-10%) associated with S-OPCAB reported in previous literature, [22][23][24] the outcomes of TM-OPCAB were very encouraging, suggesting a strong potential for this grafting technique as a safe approach for patients. Moreover, TM-OPCAB did not require lateral chest incision or rib removal, thus avoiding the occurrence of postoperative chest pain caused by intercostal nerve damage.…”

Management of perioperative myocardial ischaemia after isolated coronary artery bypass graft surgery

“…The detection of perioperative MI following isolated CABG surgery still remains a challenge 10 12–14. In most of the cases, perioperative MI is caused by a variety of graft-related causes such as technical errors and graft spasm 2 3.…”

ESC Joint Working Groups on Cardiovascular Surgery and the Cellular Biology of the Heart Position Paper: Peri-operative myocardial injury and infarction in patients undergoing coronary artery bypass graft surgery

“…New loss of viable myocardium may be also visualised by cardiac CT. 69 Multi-slice CT coronary angiography is another useful non-invasive imaging modality that can be utilized to evaluate graft patency following CABG surgery. 10 , 11 , 70 , 71 However, the radiation dose and the risks of cumulative ionising radiation need to be weighed against the obvious advantages of an early and accurate diagnosis. 72 …”