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2010 | 64 | 1-2 | 7-15
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Clinical assessment of MIDCAB-surgery by means of computed tomography

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Odległa ocena pomostowania MIDCAB z wykorzystaniem tomografi i komputerowej
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BACKGROUND The patients (pts) who underwent minimally invasive coronary artery bypass (MIDCAB) are the population where the routine noninvasive diagnostic tests are insuffi cient for the proper follow-up. Multislice spiral computed tomography (MSCT) coronary angiography allows to detect atherosclerotic lesions within coronary arteries. However, its usefulness for bypass grafts patency assessment is not recognised well enough. AIMS OF THE STUDY The aims of the study were the prospective evaluation of the cumulative rates of clinical outcome in pts who underwent MIDCAB and examination of the patency of the LIMA-LAD anastomosis in symptomatic patients in the 64-row MSCT. MATERIAL AND METHODS 176 pts (146 males, 30 females, aged 54±10 yrs) who underwent MIDCAB between 1999-2001 were followed-up for 5.5±0.8 years. MACE (major adverse cardiac events) and MAE (major adverse event) were collected. 44 pts with symptomatic exe rcise examination received MSCT evaluation. RESULTS 43 pts (24%) had history of MACE and MAE. 29 pts (16%) of them had non-cardiac-surgery related events. Six pts (3.4%) died due to cardiac reasons. Six pts (3.4%) experienced myocardial infarction and in 25 pts (14.2%) coronary intervention had to be performed (in 4 pts within LAD and 2 within LIMA-LAD anastomosis). In 44 pts MSCT coronary angiography was performed. Total occlusion of LIMA-LAD anastomosis was diagnosed in 4 pts, confi rmed by invasive coronary angiography. Two patients who had PCI of LIMA-LAD anastomosis during the follow-up had normal fl ow by connection in MSCT. CONCLUSIONS Long-term follow-up after MIDCAB revealed a relatively high rate of cardiovascular events, mainly not connected with surgical technique but with natural progression of the coronary disease. The new generation MSCT seems to be promising as means of assessment of bypass grafts patency.
WSTĘP Pacjenci po chirurgicznej rewaskularyzacji serca wymagają okresowej diagnostyki, która pozwoli na wczesne wykrycie zmian zwężających w pomostach naczyniowych. 64-rzędowa tomografi a komputerowa (MSCT) jest nieinwazyjnym badaniem szeroko stosowanym dla obrazowania zmian miażdżycowych w naczyniach wieńcowych. CEL PRACY Celem pracy była odległa kliniczna ocena pacjentów leczonych metodą MIDCAB (małoinwazyjna, endoskopowa rewaskularyzacja chirurgiczna) oraz ocena drożności pomostu LIMA-LAD z wykorzystaniem 64-rzędowej tomografi i komputerowej. MATERIAŁ I METODY Przeprowadzono badania u 176 pacjentów (146 mężczyzn, w średnim wieku 54 + 10 lat) operowanych w latach 1999–2001 (średni czas obserwacji 5,5+0,8 lat). Oceniano wystąpienie MACE (major adverse cardiac events) i MAE (major adverse events). U 44 chorych (38 mężczyzn, w średnim wieku 54 + 10 lat) z nawrotem stenokardii wykonano elektrokardiografi czną próbę wysiłkową i badanie MSCT (Toshiba Aquillon), w którym oceniano drożność pomostu LIMA-LAD. WYNIKI W trakcie obserwacji u 43 pacjentów (24%) wystąpiły zdarzenia MACE i MAE. Sześciu pacjentów (3,4%) zmarło z przyczyn sercowych. u 29 pacjentów (16%) wystąpiły zdarzenia nie związane z zabiegiem MIDCAB. U sześciu pacjentów wystąpił zawał serca, u 25 chorych wykonano przez skórną angioplastykę tętnic wieńcowych (u 4 pacjentów w zakresie LAD, u 2 w zespoleniu LIMA-LAD). W MSCT zamknięcie pomostu LIMA-LAD stwierdzono u 4 chorych, co potwierdzono w badaniu koronarograficznym. Dwóch pacjentów, którzy mieli w wywiadzie PCI LIMA- LAD wykazało w obserwacji odległej prawidłowy przepływ przez zespolenie LIMA-LAD. WNIOSKI Odległa obserwacja kliniczna pacjentów leczonych EACAB ujawniła stosunkowo dużą ilość zdarzeń naczyniowo-sercowych, nie związanych z techniką chirurgiczną, a z postępem choroby. Nowa generacja wielorzędowej tomografi i komputerowej pozwala na precyzyjną, nieinwazyjną ocenę pomostów tętniczych.

Physical description
  • MD Department of Cardiology Medical University of Silesia Silesian Heart Center Ziolowa 47 Street 40-635 Katowice, Poland Phone: +48 32 3598884 Fax: +48 32 2527407,
  • 1st Department of Cardiac Surgery, Silesian Heart Centre, Medical University of Silesia, Katowice, Poland
  • 2nd Department of Cardiology, Unit of Noninvasive Cardiovascular Diagnostics, Silesian Heart Centre, Medical University of Silesia, Katowice, Poland
  • 1st Department of Cardiac Surgery, Silesian Heart Centre, Medical University of Silesia, Katowice, Poland
  • 2nd Department of Cardiology, Silesian Heart Centre, Medical University of Silesia, Katowice, Poland
  • 2nd Department of Cardiology, Silesian Heart Centre, Medical University of Silesia, Katowice, Poland
  • 1st Department of Cardiac Surgery, Silesian Heart Centre, Medical University of Silesia, Katowice, Poland
  • Unit of Noninvasive Cardiovascular Diagnostics, 3rd Department of Cardiology, Silesian Heart Centre, Medical University of Silesia, Katowice, Poland
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