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OBJECTIVE:
Coronary artery bypass grafting (CABG) is routinely based on invasive coronary angiography (ICA) without information on myocardial perfusion. This study evaluates the outcome of CABG as well as patency rate of bypass anastomoses in relation to pre- and postoperative myocardial perfusion.
METHODS:
CABG was performed in 19 patients (18M/1F; age 65±8y) based on ICA data with a total of 62 bypass anastomoses (mean 3.1 bypass anastomoses / patient). Perfusion MRI assessed the myocardium for ischemia and scars preoperatively in a 16-segment heart model. These data were compared to postoperative values in follow-up exam (mean follow-up 13±3 months). Coronaries were preoperatively evaluated in Dual-Source CT (DSCT) for significant stenosis and postoperatively for bypass anastomoses patency.
RESULTS:
Of 304 assessed heart segments 39% (88/304) showed ischemic myocardium under stress/rest preoperatively. CABG was successful in treating 94% (83/88) of all ischemic segments with no signs of residual ischemia postoperatively. In 6% (5/88) of segments persistent ischemia was present postoperatively in 3 of 19 patients (one patient with 5 patent bypass anastomoses, 2 patient with each one occluded bypass anastomosis).
79% of all bypass anastomoses (49/62) were optimally placed to supply ischemic regions. 21% (13/62) of all bypass anastomoses were placed either into non-ischemic myocardium (9) or into scar tissue (4).
10% (6/62) of all bypass anastomoses were occluded: 3 anastomoses to non-ischemic regions (potential competitive flow), 1 anastomosis was placed into scar-tissue, 2 anastomoses to ischemic regions that therefore remained ischemic postoperatively.
CONCLUSIONS:
Even if 94% of ischemic segments were successfully revascularized, the outcome of CABG may be improved by myocardial perfusion imaging allowing for better preoperative planning with regards to the number and location of bypass graft anastomoses.