Routine intraoperative angiography improves the early patency of coronary grafts performed on the beating heart

Objectives: The techniques of performing coronary revascularization without cardiopulmonary bypass are rapidly evolving. However, concern remains regarding the accuracy of coronary artery anastomoses performed on the beating heart. This report reviews the use of intraoperative angiography in the critical appraisal of "off-pump" coronary artery bypass graft (CABG) surgery. Patients: Intraoperative angiography was performed in 24 consecutive patients undergoing CABG surgery without cardiopulmonary bypass. In all, 24 left internal mammary artery (LIMA) grafts and 18 saphenous vein bypass grafts were assessed for patency, anastomosis quality, distal and proximal runoff, and correct placement. Results: All of the saphenous vein-to-coronary artery anastomoses were widely patent, although two patients (8%) required revision of their LIMA grafts on the basis of angiographic findings. Conclusion: Intraoperative angiography permits the surgeon to immediately appraise the CABG and to revise, if necessary, any graft abnormality, thus potentially eliminating the need for early repeated surgery. The practice of routine intraoperative angiography is likely to improve the outcome of CABG surgery on the beating heart.