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Elmaghraby KM, Demitry SR, Hasaballah EA, Razik NA. Multi-slice CT coronary angiography versus invasive coronary angiography in the assessment of graft patency after coronary artery bypasses graft surgery. Egypt Heart J 2023; 75:100. [PMID: 38055084 DOI: 10.1186/s43044-023-00424-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 11/26/2023] [Indexed: 12/07/2023] Open
Abstract
BACKGROUND The long-term patency of arterial and venous grafts is crucial for the success of CABG. This study was designed to investigate graft patency using 128-slice coronary computed tomography angiography (CCTA) and compared the results with those obtained using invasive coronary angiography (ICA). In this observational cross-sectional study, we included 40 symptomatic post-CABG patients underwent CCTA and ICA within the same month. RESULTS Fifty-five percent were aged more than 60 years, and 80% were males. 67.5% had diabetes, 90% had hypertension, and 30% were smokers. Mean body mass index was 28.89 ± 5.17 kg/m2. Mean duration since CABG was 5.25 ± 4.04 years. In total, 124 native vessels and 97 grafts were assessed using CCTA and ICA. CCTA delineated 8 non-cannulated venous grafts and 6 non-cannulated left internal mammary artery grafts. CCTA required a significantly lower radiation dose (1165.77 ± 123.54 vs. 47,589.78 ± 6967.53, p < 0.001). CONCLUSION CCTA can be as accurate as ICA in assessing bypass grafts with less radiation dose, providing a non-invasive reliable tool for evaluation.
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Affiliation(s)
- Khaled M Elmaghraby
- Department of Cardiovascular Medicine, Faculty of Medicine, Assiut University, Assiut, 71515, Egypt
| | - Salwa R Demitry
- Department of Cardiovascular Medicine, Faculty of Medicine, Assiut University, Assiut, 71515, Egypt
| | - Eman A Hasaballah
- Department of Cardiovascular Medicine, Faculty of Medicine, Assiut University, Assiut, 71515, Egypt
| | - Nady A Razik
- Department of Cardiovascular Medicine, Faculty of Medicine, Assiut University, Assiut, 71515, Egypt.
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Masroor M, Ahmad A, Wang Y, Dong N. Assessment of the Graft Quality and Patency during and after Coronary Artery Bypass Grafting. Diagnostics (Basel) 2023; 13:diagnostics13111891. [PMID: 37296743 DOI: 10.3390/diagnostics13111891] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 05/03/2023] [Accepted: 05/23/2023] [Indexed: 06/12/2023] Open
Abstract
Coronary artery bypass grafting (CABG) is the gold standard procedure for multi vessels and left main coronary artery disease. The prognosis and survival outcomes of CABG surgery are highly dependent on the patency of the bypass graft. Early graft failure which can occur during or soon after CABG remains a significant issue, with reported incidences of 3-10%. Graft failure can lead to refractory angina, myocardial ischemia, arrhythmias, low cardiac output, and fatal cardiac failure, emphasizing the importance of ensuring graft patency during and after surgery to prevent such complications. Technical errors during anastomosis are among the leading causes of early graft failure. To address this issue, various modalities and techniques have been developed to evaluate graft patency during and after CABG surgery. These modalities aim to assess the quality and integrity of the graft, thus enabling surgeons to identify and address any issues before they lead to significant complications. In this review article, we aim to discuss the strengths and limitations of all available techniques and modalities, with the goal to identify the best modality for evaluating graft patency during and after CABG surgery.
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Affiliation(s)
- Matiullah Masroor
- Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
- Department of Cardiothoracic and Vascular Surgery, Amiri Medical Complex, Qargha Rd., Kabul 1010, Afghanistan
| | - Ashfaq Ahmad
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Yixuan Wang
- Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Nianguo Dong
- Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
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3
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Layton GR, Ladak SS, Abbasciano R, McQueen LW, George SJ, Murphy GJ, Zakkar M. The Role of Preservation Solutions upon Saphenous Vein Endothelial Integrity and Function: Systematic Review and UK Practice Survey. Cells 2023; 12:815. [PMID: 36899951 PMCID: PMC10001248 DOI: 10.3390/cells12050815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Revised: 02/19/2023] [Accepted: 02/22/2023] [Indexed: 03/08/2023] Open
Abstract
The long saphenous vein is the most used conduit in cardiac surgery, but its long-term patency is limited by vein graft disease (VGD). Endothelial dysfunction is a key driver of VGD; its aetiology is multi-factorial. However emerging evidence identifies vein conduit harvest technique and preservation fluids as causal in their onset and propagation. This study aims to comprehensively review published data on the relationship between preservation solutions, endothelial cell integrity and function, and VGD in human saphenous veins harvested for CABG. The review was registered with PROSPERO (CRD42022358828). Electronic searches of Cochrane Central Register of Controlled Trials, MEDLINE, and EMBASE databases were undertaken from inception until August 2022. Papers were evaluated in line with registered inclusion and exclusion criteria. Searches identified 13 prospective, controlled studies for inclusion in the analysis. All studies used saline as a control solution. Intervention solutions included heparinised whole blood and saline, DuraGraft, TiProtec, EuroCollins, University of Wisconsin (UoW), buffered, cardioplegic and Pyruvate solutions. Most studies demonstrated that normal saline appears to have negative effects on venous endothelium and the most effective preservation solutions identified in this review were TiProtec and DuraGraft. The most used preservation solutions in the UK are heparinised saline or autologous whole blood. There is substantial heterogeneity both in practice and reporting of trials evaluating vein graft preservation solutions, and the quality of existing evidence is low. There is an unmet need for high quality trials evaluating the potential for these interventions to improve long-term patency in venous bypass grafts.
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Affiliation(s)
- Georgia R. Layton
- Department of Cardiovascular Sciences, University of Leicester, Leicester LE1 7RH, UK
| | - Shameem S. Ladak
- Department of Cardiovascular Sciences, University of Leicester, Leicester LE1 7RH, UK
| | | | - Liam W. McQueen
- Department of Cardiovascular Sciences, University of Leicester, Leicester LE1 7RH, UK
| | - Sarah J. George
- Department of Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol BS2 1UDD, UK
| | - Gavin J. Murphy
- Department of Cardiovascular Sciences, University of Leicester, Leicester LE1 7RH, UK
| | - Mustafa Zakkar
- Department of Cardiovascular Sciences, University of Leicester, Leicester LE1 7RH, UK
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Ranjan R, Matthew Sales K, Adhikary AB. Computed Tomography-Based Angiographic Evaluation of Graft Patency Rate After Coronary Artery Bypass Graft Surgery in Bangladesh. Cureus 2022; 14:e28902. [PMID: 36237804 PMCID: PMC9544526 DOI: 10.7759/cureus.28902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/07/2022] [Indexed: 11/08/2022] Open
Abstract
Background This study aims to assess the graft patency rate following coronary artery bypass graft (CABG) surgery using noninvasive CT angiography. Materials and methods A total of 68 patients were retrospectively evaluated with CT angiography (group I: 34 patients with coronary endarterectomy (CE) and group II: 34 patients without CE). CE was performed in multi-segmental diffuse coronary artery disease (CAD) or when calcified or extremely thick plaques made anastomosis troublesome. A team of two experts, an interventional radiologist and a cardiac surgeon, did the evaluations of graft patency rate. Results A total of 205 bypass grafts were evaluated in 68 post-CABG status patients (110 grafts in group I and 95 grafts in group II; moreover, 82 were arterial and 123 were venous grafts). Post CABG, CT angiography demonstrated a graft patency rate of about 90% in both study groups at five years follow up, which was statistically insignificant (P > 0.05) in terms of graft patency rate. Following CE, five-year angina-free survival rates were 89% and 91% in groups I and II, respectively. Conclusion CABG surgery with endarterectomy is reliable and effective. It achieves the desired surgical myocardial revascularization in patients with diffuse calcified CAD having no alternative options for adequate myocardial revascularization.
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Mansour HH, Alajerami YS, Abushab KM, Quffa KM. The diagnostic accuracy of coronary computed tomography angiography in patients with and without previous coronary interventions. J Med Imaging Radiat Sci 2022; 53:81-86. [PMID: 34987013 DOI: 10.1016/j.jmir.2021.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 09/28/2021] [Accepted: 10/18/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Invasive coronary angiography (ICA) is the gold standard for imaging coronary arteries and the severity of coronary artery disease (CAD). Coronary computed tomography angiography (CCTA) has undergone remarkable progress in the diagnosis of CAD. OBJECTIVES To evaluate the effect of prior vs no previous coronary interventions on the diagnostic accuracy of CCTA as an alternative to ICA to improve health outcomes for patients with suspected CAD. METHODS A prospective cohort study was carried out among patients suspected of CAD and for evaluation of grafts and stents to investigate recurrent ischemic symptoms. 120 patients imaged by CCTA were then referred to ICA, which is considered the gold standard. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of CCTA were assessed relative to ICA. RESULTS Based on a per-patient analysis, the comparison with ICA reveals variations in sensitivity, specificity, PPV, NPV and accuracy of CCTA. In patients without any previous coronary interventions, the sensitivity was 97.8%, and specificity was 95.6%. The PPV and NPV were 97.8% and 95.5%, respectively. Regarding patients with coronary artery bypass grafts (CABG), the sensitivity was 95% and specificity 100%. The PPV and NPV were 100% and 90.9%, respectively. Regarding patients with prior percutaneous coronary intervention (PCI), the results were a sensitivity of 84.6%, specificity of 77.8%, PPV of 84.6% and NPV of 77.8%. CONCLUSION CCTA is a powerful diagnostic tool, especially for the evaluation of the major coronary arteries and evaluation of patients with prior CABG. ICA is recommended for evaluation of patients with an intracoronary stent.
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Affiliation(s)
- Husam H Mansour
- Radiology Department, Al-Shifa Hospital, Gaza-Palestine, Palestine; Medical Imaging Department, Al-Azhar University, Gaza-Palestine, Palestine.
| | - Yasser S Alajerami
- Medical Imaging Department, Al-Azhar University, Gaza-Palestine, Palestine
| | - Khaled M Abushab
- Medical Imaging Department, Al-Azhar University, Gaza-Palestine, Palestine
| | - Khetam M Quffa
- Medical Imaging Department, Al-Azhar University, Gaza-Palestine, Palestine
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Tridandapani S, Banait-Deshmane S, Aziz MU, Bhatti P, Singh SP. Coronary computed tomographic angiography: A review of the techniques, protocols, pitfalls, and radiation dose. J Med Imaging Radiat Sci 2021; 52:S1-S11. [PMID: 34565701 DOI: 10.1016/j.jmir.2021.08.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 08/13/2021] [Accepted: 08/28/2021] [Indexed: 11/26/2022]
Abstract
Coronary computed tomographic angiography (CCTA) is a viable alternative to catheter coronary angiography for several clinical indications, chiefly because it is fast and non-invasive. For effective clinical use of CCTA, various technical and patient factors should be considered. In this brief review article, we discuss the indication and contraindications for CCTA, technical requirements for CCTA including radiation dose, patient preparation principles, image post-processing, and pitfalls and artifacts of CCTA.
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Affiliation(s)
- Srini Tridandapani
- Department of Radiology, University of Alabama, Birmingham, AL, USA; School of Electrical and Computer Engineering, Georgia Institute of Technology, Atlanta, GA, USA.
| | | | | | - Pamela Bhatti
- School of Electrical and Computer Engineering, Georgia Institute of Technology, Atlanta, GA, USA
| | - Satinder P Singh
- Department of Radiology, University of Alabama, Birmingham, AL, USA
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Mansour HH, Alajerami YS, Foster T. Estimation of Radiation Doses and Lifetime Attributable Risk of Radiation-induced Cancer from A Single Coronary Artery Bypass Graft Computed Tomography Angiography. ELECTRONIC JOURNAL OF GENERAL MEDICINE 2021. [DOI: 10.29333/ejgm/11208] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Coronary Computer Tomography Angiography in 2021-Acquisition Protocols, Tips and Tricks and Heading beyond the Possible. Diagnostics (Basel) 2021; 11:diagnostics11061072. [PMID: 34200866 PMCID: PMC8230532 DOI: 10.3390/diagnostics11061072] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 06/06/2021] [Accepted: 06/09/2021] [Indexed: 01/09/2023] Open
Abstract
Recent technological advances, together with an increasing body of evidence from randomized trials, have placed coronary computer tomography angiography (CCTA) in the center of the diagnostic workup of patients with coronary artery disease. The method was proven reliable in the diagnosis of relevant coronary artery stenosis. Furthermore, it can identify different stages of the atherosclerotic process, including early atherosclerotic changes of the coronary vessel wall, a quality not met by other non-invasive tests. In addition, newer computational software can measure the hemodynamic relevance (fractional flow reserve) of a certain stenosis. In addition, if required, information related to cardiac and valvular function can be provided with specific protocols. Importantly, recent trials have highlighted the prognostic relevance of CCTA in patients with coronary artery disease, which helped establishing CCTA as the first-line method for the diagnostic work-up of such patients in current guidelines. All this can be gathered in one relatively fast examination with minimal discomfort for the patient and, with newer machines, with very low radiation exposure. Herein, we provide an overview of the current technical aspects, indications, pitfalls, and new horizons with CCTA, providing examples from our own clinical practice.
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Krysztofiak T, Ahmad F, Adams J, Stobo DB, Good R, Byrne J. The value of non-invasive computed tomography coronary angiography in imaging patients with coronary artery bypass grafts. Scott Med J 2020; 65:76-80. [PMID: 32580687 DOI: 10.1177/0036933020936274] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Invasive coronary angiography (ICA) is associated with higher complication rates in patients following coronary artery bypass surgery (CABG). CT coronary angiography (CTCA) has emerged as an attractive alternative. We assessed the impact of CTCA on subsequent ICA. METHODS We identified 213 CABG patients undergoing CTCA between 2015 and 2018. In 151 the indication was suspected recurrence of angina. We then identified patients undergoing ICA within 1 year of CTCA. RESULTS CTCA obviated the need for ICA in 115 cases (76%). CTCA was better at identifying targets for percutaneous coronary intervention (PCI) to saphenous vein grafts (SVG's) than to native vessels (89% vs 47%). 7 out of 10 lesions of "probable" significance by CTCA proved flow-limiting, and 4 out of 13 "indeterminate" lesions. CTCA concordance was 97% for left internal mammary (LIMA) grafts. CONCLUSION CTCA directed management in a majority of patients without ICA. It identified a cohort of patients likely to be candidates for SVG PCI, but was less effective in identifying PCI targets in the native vessels. CTCA renders invasive LIMA cannulation redundant unless a target lesion is suspected.
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Affiliation(s)
- T Krysztofiak
- Cardiology Clinical Fellow, Department of Cardiology, Golden Jubilee National Hospital, UK
| | - F Ahmad
- Cardiology Specialist Registrar, Department of Cardiology, Golden Jubilee National Hospital, UK
| | - J Adams
- Consultant Cardiologist, Department of Cardiology, Golden Jubilee National Hospital, UK
| | - D B Stobo
- Consultant Radiologist, Department of Radiology, Golden Jubilee National Hospital, UK
| | - R Good
- Consultant Cardiologist, Department of Cardiology, Golden Jubilee National Hospital, UK
| | - J Byrne
- Consultant Cardiologist, Department of Cardiology, Golden Jubilee National Hospital, UK
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Jovin DG, Katlaps GJ, Sumption KF. Coronary artery bypass graft markers: history, usage, and effects. Gen Thorac Cardiovasc Surg 2020; 68:453-458. [DOI: 10.1007/s11748-020-01325-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2019] [Accepted: 02/21/2020] [Indexed: 01/09/2023]
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Ieroncig F, Breau JB, Bélair G, David LP, Noiseux N, Hatem R, Avram R. Novel Approaches to Define Outcomes in Coronary Revascularization. Can J Cardiol 2019; 35:967-982. [DOI: 10.1016/j.cjca.2018.12.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Revised: 12/10/2018] [Accepted: 12/10/2018] [Indexed: 01/10/2023] Open
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Jubran A, Willemink MJ, Nieman K. Coronary CT in Patients with a History of PCI or CABG: Helpful or Harmful? CURRENT CARDIOVASCULAR IMAGING REPORTS 2019. [DOI: 10.1007/s12410-019-9496-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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Chartrand-Lefebvre C, Stevens LM, Mansour S, Noiseux N. CT angiography for coronary graft assessment. J Thorac Dis 2018; 10:E77-E78. [PMID: 29600110 DOI: 10.21037/jtd.2017.11.136] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Carl Chartrand-Lefebvre
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montréal (Québec), Canada.,Department of Radiology, Centre Hospitalier de l'Université de Montréal (CHUM), Montréal (Québec), Canada
| | - Louis-Mathieu Stevens
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montréal (Québec), Canada.,Division of Cardiac Surgery, Centre Hospitalier de l'Université de Montréal (CHUM), Montréal (Québec), Canada
| | - Samer Mansour
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montréal (Québec), Canada.,Division of Cardiology, Centre Hospitalier de l'Université de Montréal (CHUM), Montréal (Québec), Canada
| | - Nicolas Noiseux
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montréal (Québec), Canada.,Division of Cardiac Surgery, Centre Hospitalier de l'Université de Montréal (CHUM), Montréal (Québec), Canada
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