TY - JOUR
T1 - Frequent change of procedure during coronary artery bypass surgery suggests insufficient preoperative diagnostic strategy
AU - Eckardt, Rozy
AU - Kjeldsen, Bo Juel
AU - Thayssen, Per
AU - Vach, Werner
AU - Haghfelt, Torben
AU - Høilund-Carlsen, Poul F.
AU - Andersen, Lars Ib
PY - 2007/6/1
Y1 - 2007/6/1
N2 - We sought to evaluate how often and in what way surgeons change peroperatively their preoperative coronary artery bypass grafting strategy and to what degree these changes affect postoperative graft patency. A series of 109 patients with stable angina pectoris and at least one occluded coronary artery participated. The surgeon filled in a questionnaire pertaining to the planned localization and number of grafts. These estimates were compared to procedures actually performed and with the angiographic outcome six months after bypass surgery. Planned and actually inserted grafts disclosed a discrepancy in 22% of the patients, resulting in a lower or higher number of grafts than pre-operatively estimated. The difference in shift rates between the three sites, left anterior descending, left circumflex, and right coronary artery, was significant (P=0.014). Patency rates were highest when only preoperatively planned grafts were inserted. When shifts occurred, no matter in which direction, it resulted in a decreased patency rate of the inserted grafts. This finding was significant for LAD (P=0.037). Our findings might indicate the necessity of future studies with the use of scintigraphy or fractional flow reserve as physiological adjuncts to angiography for more targeted revascularization.
AB - We sought to evaluate how often and in what way surgeons change peroperatively their preoperative coronary artery bypass grafting strategy and to what degree these changes affect postoperative graft patency. A series of 109 patients with stable angina pectoris and at least one occluded coronary artery participated. The surgeon filled in a questionnaire pertaining to the planned localization and number of grafts. These estimates were compared to procedures actually performed and with the angiographic outcome six months after bypass surgery. Planned and actually inserted grafts disclosed a discrepancy in 22% of the patients, resulting in a lower or higher number of grafts than pre-operatively estimated. The difference in shift rates between the three sites, left anterior descending, left circumflex, and right coronary artery, was significant (P=0.014). Patency rates were highest when only preoperatively planned grafts were inserted. When shifts occurred, no matter in which direction, it resulted in a decreased patency rate of the inserted grafts. This finding was significant for LAD (P=0.037). Our findings might indicate the necessity of future studies with the use of scintigraphy or fractional flow reserve as physiological adjuncts to angiography for more targeted revascularization.
KW - Chi-Square Distribution
KW - Coronary Angiography
KW - Coronary Artery Bypass
KW - Coronary Disease
KW - Decision Making
KW - Humans
KW - Outcome Assessment (Health Care)
KW - Patient Care Planning
KW - Physician's Practice Patterns
KW - Prospective Studies
KW - Questionnaires
KW - Statistics, Nonparametric
KW - Vascular Patency
U2 - 10.1510/icvts.2006.149914
DO - 10.1510/icvts.2006.149914
M3 - Journal article
C2 - 17669849
VL - 6
SP - 298
EP - 302
JO - Interactive Cardiovascular and Thoracic Surgery
JF - Interactive Cardiovascular and Thoracic Surgery
SN - 1569-9293
IS - 3
ER -