| A Randomized Comparison of Intraoperative Angiography and Transit-Time Flow Measurement to Detect Technical Errors in Coronary Bypass Grafts |
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Nimesh Desai, George Christakis, Bernard Goldman, Senri Miwa, David Kodama, Stephen Fremes; Sunnybrook and Women's College Health Sciences Centre, Toronto, ON, Canada.
BACKGROUND:
Modern angiography studies have shown that 5% to 11% of grafts experience early failure. These may be preventable if identified intraoperatively. The purpose of this investigation was to compare the sensitivity and specificity of transit time ultrasound flow measurement(TTF) to indocyanine green (ICG) LASER fluorescent-dye graft angiography, to detect graft problems using x-ray angiography as a gold standard.
Patents undergoing isolated CABG were enrolled in the study. Patients were intraoperatively randomized to receive patency assessment with either 1. ICG angiography (Novadaq Spy(TM) Angiography system) then TTF (Medtronic MediStim(TM) System) or TTF then ICG angiography(i.e crossover study design). Patients underwent x-ray angiography on postoperative day 4. The primary endpoint of the trial was to determine the sensitivity and specificity of the two techniques to detect >50% lesions in the graft or immediate distal vessel.
The data presented below are from a pre-planned interim analysis of the trial results. 53 patients were enrolled in the trial. The sensitivity for detecting >50% stenoses was 100% for ICG angiography and 25% for TTF, p=0.04. The sensitivity for detecting total occlusion was 100% for both techniques. Specificity for detecting >50% stenoses was 100% for ICG angiography and 80% for TTF, p=0.1. Specificity for total graft occlusion was 100% for both techniques.
ICG angiography provides superior sensitivity and specificity for detecting hemodynamically significant graft errors versus TTF flow measurement. Final results of this trial will be presented at the meeting.
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