Back to Annual Meeting Posters

OBJECTIVE:Intraoperative detection of deeply embedded coronary arteries is difficult, especially in off-pump coronary bypass surgery. From June 2010, we introduced high-frequency epicardial ultrasound for assessing embedded arteries or evaluating the suitable anastomotic sites during off-pump coronary bypass surgery.
METHODS: Between June 2010 and June 2011, 89 consecutive patients underwent isolated coronary bypass surgery in our institution. These patients consisted of 72 males and 17 females with a mean age of 67.9 ± 10.9 years, and emergent operations were performed in 24 patients (including 15 patients with intra-aortic balloon pumping preoperatively). We routinely use the Veri Q system (MedStim, Oslo, Norway) to detect the target vessels and suitable anastomotic sites in the operation.
RESULTS: All patients underwent revascularization using the off-pump technique without emergent conversion to cardiopulmonary bypass during operation. In 14 patients (15.7%, 14/89), the target vessels or suitable anastomotic sites could not be identified either visually or on palpation. The detail of 14 patients is as follow; in 8 patients, the targets were embedded by myocardium (n = 7) or by fat tissue (n = 1). In 2 patients, coronary arteries could not be detected because of epicardial inflammation or adhesion. In 4 patients, detection of calcified sites caused a change in anastomotic site. The target vessels consisted of left anterior descending coronary artery (n = 10), left circumflex coronary artery (n = 3), and right coronary artery (n = 2). In all 14 patients, the target exposure and anastomosis under beating conditions were successful and we achieved complete revascularization. No difference was found in surgical results and post-operative outcomes between the 14 patients and the others.
CONCLUSION: High-frequency epicardial ultrasound is useful in detecting embedded coronary arteries or suitable anastomotic sites in off-pump coronary bypass surgery.