Jan-Alexis Tremblay, Presenter: Nothing to Disclose

Carl Chartrand-Lefebvre MD, Abstract Co-Author: Research, Bracco Group

Martin Chandonnet MD, Abstract Co-Author: Nothing to Disclose

Sofiane Hadjadj MD, Abstract Co-Author: Nothing to Disclose

Gilles P. Soulez MD, Abstract Co-Author: Speaker, Bracco Group Speaker, Siemens AG Research grant, Siemens AG Research grant, Bracco Group Research grant, Cook Group Incorporated Research grant, Object Research Systems Inc

Louis-Mathieu Stevens MD,PHD, Abstract Co-Author: Nothing to Disclose

Nicolas Noiseux MD,MSc, Abstract Co-Author: Nothing to Disclose

To assess with 256-slice CT angiography (CTA) the long-term patency of a novel surgical strategy involving a saphenous vein (SV) bridge to bypass the left anterior descending artery (LAD) and diagonal arteries (DA), distributing the internal mammary artery (IMA) flow over all the anterior myocardial territory. This coronary artery bypass graft (CABG) technique allows high flow in IMA pedicle, as well as avoidance of aortic manipulation.

Twenty patients (18M, mean age 69, mean heart rate 58 bpm) which underwent CABG with both an IMA-SV bridge and conventional vein grafts were evaluated with prospectively ECG-gated 256-slice CTA (2×128×0.625 mm collimation, 270 msec gantry rotation time) at a median postoperative time of 51 mo. A SV bridge segment was defined as a portion of the SV bridge included between the IMA inflow anastomosis and a distal anastomosis on the anterior territory. Graft patency index was assessed by two independent observers and defined as the percentage of patent (non-occluded) segments out of the total number of segments for all patients. Graft patency was also assessed on a scale of 1 to 3: 1) normal lumen (maximal diameter stenosis <50%); 2) significant stenosis (≥50% stenosis); 3) graft occlusion. Image quality of the proximal anastomosis, graft body, distal anastomosis, and postanastomotic coronary artery was graded as evaluable or not. Effective radiation dose was calculated.

Among a total of 99 graft segments, 98 (99,0%) were evaluable. IMA patency was 100%. Among 42 evaluable SV bridge segments, 2 (4,8%) presented a significant stenosis and 4 (9,5%) were occluded. In comparison, among 36 evaluable conventional vein graft segments, 1 (2,8%) presented a significant stenosis and 6 (16,7%) were occluded. Graft patency index was 90,5% for the SV bridge segments and 83,3% for the conventional vein grafts (p >.99). Interobserver agreement for graft patency was 100 %. Mean effective radiation dose was 10,2 mSv.

Long-term patency of a composite-sequential graft to bypass the anterior territory is 90,5%, which is more than the one-year patency rate for conventional vein grafts. It suggests the viability of this novel surgical technique.

A non invasive and robust assessment of novel and morphologically complex coronary artery graft techniques can be performed with prospectively ECG-gated large volume coverage CTA.

Tremblay, J, Chartrand-Lefebvre, C, Chandonnet, M, Hadjadj, S, Soulez, G, Stevens, L, Noiseux, N, Assessment of a Novel Surgical Strategy with Composite-sequential Graft to Bypass the Anterior Myocardial Territory with Prospectively ECG-gated 256-slice CT.  Radiological Society of North America 2011 Scientific Assembly and Annual Meeting, November 26 - December 2, 2011 ,Chicago IL. http://archive.rsna.org/2011/11034348.html