Objective: This study was performed to evaluate the correlation between intraoperative color Doppler ultrasound assessment of anastomoses of the left internal mammary artery (LIMA) to the left anterior descending coronary artery (LAD) performed on the beating heart and the angiographic assessment after 8 months.
Methods: Twenty patients (M/F ratio, 14:6; mean age, 62 +/- 8 years) underwent epicardial color Doppler ultrasound imaging with a 10-MHz linear array GE Vingmed transducer combined with a GE Vingmed System FiVe. Transit-time flowmetry was used as intraoperative control. Follow-up coronary angiography after a median of 245 days (range, 128-320 days) allowed assessment of thrombolysis in myocardial infarction (TIMI) flow and FitzGibbon grading in all patients. Detailed quantitative coronary angiography was performed in 10 patients with an emphasis on comparing the LAD diameter at the toe of the anastomosis (D1) and in the downstream LAD (D2).
Results: Intraoperative ultrasound analysis revealed 19 patent LIMA-LAD anastomoses (95%). A >50% stenosis was detected in 1 anastomosis (5%), which was subsequently revised successfully. Follow-up angiographic evaluation showed TIMI-III flow and FitzGibbon grade A in 18 of 20 anastomoses (90%). One anastomosis was occluded, and one had FitzGibbon grade B stenosis. The D1/D2 ratios of the LAD measurements assessed with intraoperative ultrasound and follow-up quantitative coronary angiography were significantly correlated (r2 = 0.62; P < .01).
Conclusion: Intraoperative color Doppler ultrasound allows a detailed evaluation of LIMA-LAD anastomoses during off-pump surgery, and the results correlate significantly with those of angiographic evaluation after 8 months. The present study shows that epicardial ultrasound is a promising tool for verification of LIMA-LAD anastomoses performed on the beating heart and may reduce the risk of impaired graft flow caused by technical errors.
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