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Impact of Epicardial Ultrasound in Patient with Embedded Coronary Artery in Off-Pump Coronary Bypass Surgery
Masato Hayakawa, Tohru Asai, Takeshi Kinoshita, Tomoaki Suzuki.
Shiga University of Medical Science, Otsu City, Japan.

OBJECTIVE: We have focused on off-pump coronary artery bypass (CABG) with skeletonized ITA and GEA for over 10 years. During this period, over 1000 patients underwent complete functional revascularization by the off-pump technique without conversion to cardiopulmonary bypass. However, it is often difficult to detect embedded coronary arteries on beating heart. From June 2010, we routinely use a high-frequency epicardial ultrasound (ECUS) for assessing embedded arteries. The purposes of the present study were to report the clinical outcomes in patients before or after introduction of ECUS and to assess its impact in patients with embedded target vessels.
METHODS: Between June 2008 and June 2012, 364 consecutive patients underwent isolated CABG in our institution. In 34 patients (including 28 (82.4%) patients with three vessels disease and 5 (14.7%) patients with emergency operation), the target sites could not be identified either visually or on palpation. We divided them into two groups, pre-introduction group (non-ECUS group, 15 patients including 15 anastomotic sites) or post-introduction group (ECUS group, 19 patients including 25 anastomotic sites).
RESULTS: The preoperative profiles and surgical data of the two groups were not significantly different. The embedded target sites were located in LAD (7 anastomotic sites in non-ECUS group vs. 16 in ECUS group), LCX (6 in non-ECUS group vs. 6 in ECUS group) and RCA (2 in non-ECUS group vs. 3 in ECUS group). ECUS facilitated finding the best target sites and constructing anastomoses even with embedded targets. All patients underwent complete functional revascularization by the off-pump technique without conversion to cardiopulmonary bypass. The 30-day mortality was 0% and no significant difference was found in postoperative complications between the two groups. All grafts were confirmed to be patent by postoperative angiograms.
CONCLUSIONS: ECUS is extremely useful in detecting and assessing embedded coronary arteries especially in off-pump coronary bypass surgery.


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