Skip to main content
SpringerLink
Log in

Multidetector CT Angiography for Coronary Bypass Graft Assessment and Reoperative Cardiac Surgery

  • Chapter
  • First Online:
CT of the Heart

Part of the book series: Contemporary Medical Imaging ((CMI))

  • 2775 Accesses

Abstract

Multidetector coronary computed tomographic angiography (CCTA) is a useful tool for diagnosing and evaluating coronary artery disease, as well as elucidating mediastinal anatomy pertinent to coronary artery bypass grafting (CABG). Multiple developments in hardware, software, and technique have contributed to improved spatial and temporal resolution while imaging the heart, giving high-quality information on native coronary arteries and bypass grafts. While CCTA is not routinely used as a sole test to proceeding with CABG, it provides more information on mediastinal anatomy than ICA and is indispensable for minimally invasive CABG and off-pump CABG and for evaluating potential arterial grafts for all-arterial bypass. In addition, CCTA has been shown to accurately assess coronary artery bypass grafts for stenosis and overall patency, in both venous and arterial grafts. CCTA is indispensable to reoperative surgery in determining the location of bypass grafts and other mediastinal structures in order to avoid damage during sternal reentry. The current status of multidetector CT (MDCT) for use with CABG is promising, and advances in newer-generation CT scanners may lead to it becoming the “gatekeeper” to the catheterization lab and the operating room.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 149.00
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
Hardcover Book
USD 199.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Roach GW, et al. Adverse cerebral outcomes after coronary bypass surgery. Multicenter Study of Perioperative Ischemia Research Group and the Ischemia Research and Education Foundation Investigators. N Engl J Med. 1996;335(25):1857–63.

    Article  CAS  PubMed  Google Scholar 

  2. Loop FD, et al. Influence of the internal-mammary-artery graft on 10-year survival and other cardiac events. N Engl J Med. 1986;314(1):1–6.

    Article  CAS  PubMed  Google Scholar 

  3. Zhang B, et al. Comparison of graft patency between off-pump and on-pump coronary artery bypass grafting: an updated meta-analysis. Ann Thorac Surg. 2014;97(4):1335–41.

    Article  PubMed  Google Scholar 

  4. Locker C, et al. Multiple arterial grafts improve late survival of patients undergoing coronary artery bypass graft surgery: analysis of 8622 patients with multivessel disease. Circulation. 2012;126(9):1023–30.

    Article  PubMed  Google Scholar 

  5. Arad Y, et al. Predictive value of electron beam computed tomography of the coronary arteries. 19-month follow-up of 1173 asymptomatic subjects. Circulation. 1996;93(11):1951–3.

    Article  CAS  PubMed  Google Scholar 

  6. Godwin JD, et al. Clinical value of coronary bypass graft evaluation with CT. AJR Am J Roentgenol. 1983;140(4):649–55.

    Article  CAS  PubMed  Google Scholar 

  7. Daniel WG, et al. Value and limitations of computed tomography in assessing aortocoronary bypass graft patency. Circulation. 1983;67(5):983–7.

    Article  CAS  PubMed  Google Scholar 

  8. Tello R, et al. Spiral CT evaluation of coronary artery bypass graft patency. J Comput Assist Tomogr. 1993;17(2):253–9.

    Article  CAS  PubMed  Google Scholar 

  9. Engelmann MG, et al. Accuracy of spiral computed tomography for identifying arterial and venous coronary graft patency. Am J Cardiol. 1997;80(5):569–74.

    Article  CAS  PubMed  Google Scholar 

  10. Becker CR, et al. Current development of cardiac imaging with multidetector-row CT. Eur J Radiol. 2000;36(2):97–103.

    Article  CAS  PubMed  Google Scholar 

  11. Flohr T, Schmidt B. Technical aspects of dual energy CT with dual source CT systems. In: Carrascosa PM, Cury RC, Garcia MJ, Leipseic JA, editors. Dual-energy CT in cardiovascular imaging. New York: Springer International Publishing; 2015. p. 11–32.

    Chapter  Google Scholar 

  12. Mangold S, et al. Diagnostic accuracy of coronary CT angiography using 3rd-generation dual-source CT and automated tube voltage selection: clinical application in a non-obese and obese patient population. Eur Radiol. 2017;27:2298.

    Article  PubMed  Google Scholar 

  13. Treede H, et al. Multidetector computed tomography (MDCT) in coronary surgery: first experiences with a new tool for diagnosis of coronary artery disease. Ann Thorac Surg. 2002;74(4):S1398–402.

    Article  PubMed  Google Scholar 

  14. Plass A, et al. Sixteen-channel multidetector row computed tomography versus coronary angiography in a surgical view. Heart Surg Forum. 2006;9(2):E572–8.

    Article  PubMed  Google Scholar 

  15. Bedi HS, Gill JA, Bakshi SS. Can we perform coronary artery bypass grafting on the basis of computed tomographic angiography alone? A comparison with conventional coronary angiography. Eur J Cardiothorac Surg. 2008;33(4):633–8.

    Article  PubMed  Google Scholar 

  16. Otero HJ, Steigner ML, Rybicki FJ. The “post-64” era of coronary CT angiography: understanding new technology from physical principles. Radiol Clin N Am. 2009;47(1):79–90.

    Article  PubMed  Google Scholar 

  17. Sadigh G, et al. Impact of coronary CT angiography on surgical decision-making for coronary artery bypass graft surgery. Acad Radiol. 2013;20(9):1083–90.

    Article  PubMed  Google Scholar 

  18. Botman CJ, et al. Does stenosis severity of native vessels influence bypass graft patency? A prospective fractional flow reserve-guided study. Ann Thorac Surg. 2007;83(6):2093–7.

    Article  PubMed  Google Scholar 

  19. Shiono Y, et al. Impact of functional focal versus diffuse coronary artery disease on bypass graft patency. Int J Cardiol. 2016;222:16–21.

    Article  PubMed  Google Scholar 

  20. Curzen NP, et al. Does the routine availability of CT-derived FFR influence management of patients with stable chest pain compared to CT angiography alone?: The FFRCT RIPCORD Study. JACC Cardiovasc Imaging. 2016;9(10):1188–94.

    Article  PubMed  Google Scholar 

  21. Alexopoulos D, Moulias A. In the search of coronary calcium. Int J Cardiol. 2013;167(2):310–7.

    Article  PubMed  Google Scholar 

  22. Kepka C, et al. Computed tomography to predict surgical revascularization of a left anterior descending artery occlusion incompletely visualized by conventional angiography. J Thorac Imaging. 2012;27(3):184–93.

    Article  PubMed  Google Scholar 

  23. Jones CM, et al. Multi-slice computed tomography in coronary artery disease. Eur J Cardiothorac Surg. 2006;30(3):443–50.

    Article  PubMed  Google Scholar 

  24. Hsiao EM, Rybicki FJ, Steigner M. CT coronary angiography: 256-slice and 320-detector row scanners. Curr Cardiol Rep. 2010;12(1):68–75.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Bauer EP, et al. Internal mammary artery anomalies. Thorac Cardiovasc Surg. 1990;38(5):312–5.

    Article  CAS  PubMed  Google Scholar 

  26. Prasad A, et al. Prevalence and treatment of proximal left subclavian artery stenosis in patients referred for coronary artery bypass surgery. Int J Cardiol. 2009;133(1):109–11.

    Article  PubMed  Google Scholar 

  27. Byrne C, et al. Ten-year experience in subclavian revascularisation. A parallel comparative observational study. Vascular. 2016;24(4):378–82.

    Article  CAS  PubMed  Google Scholar 

  28. Rigatelli G, Rigatelli G. Simultaneous preoperative brachiocephalic angiography and coronary angiography to prevent coronary-subclavian steal syndrome in coronary surgery candidates. Heart Surg Forum. 2005;8(3):E175–7.

    Article  PubMed  Google Scholar 

  29. Holzhey DM, Rastan AJ, Falk V, Mohr FW. Minimally invasive myocardial revascularization. In: Cohn LH, editor. Cardiac surgery in the adult. 4th ed. New York: McGraw-Hill Education; 2012. p. 553–66.

    Google Scholar 

  30. Gulbins H, et al. Preoperative 3D-reconstructions of ultrafast-CT images for the planning of minimally invasive direct coronary artery bypass operation (MIDCAB). Heart Surg Forum. 1998;1(2):111–5.

    CAS  PubMed  Google Scholar 

  31. Schachner T, et al. Does preoperative multislice computed tomography predict operative times in total endoscopic coronary artery bypass grafting? Heart Surg Forum. 2005;8(5):E314–8.

    Article  PubMed  Google Scholar 

  32. Wehman B, et al. Patient anatomy predicts operative time in robotic totally endoscopic coronary artery bypass surgery. Interact Cardiovasc Thorac Surg. 2014;19(4):572–6.

    Article  PubMed  Google Scholar 

  33. Stevens LM, et al. Conversion after off-pump coronary artery bypass grafting: the CORONARY trial experience. Eur J Cardiothorac Surg. 2017 Mar 1;51(3):539–46.

    PubMed  Google Scholar 

  34. Benedetto U, et al. Searching for the second best graft for coronary artery bypass surgery: a network meta-analysis of randomized controlled trialsdagger. Eur J Cardiothorac Surg. 2015;47(1):59–65; discussion 65.

    Article  PubMed  Google Scholar 

  35. Yamaguchi A, et al. Three-dimensional computed tomographic angiography as preoperative evaluation of a patent internal thoracic artery graft. J Thorac Cardiovasc Surg. 2000;120(4):811–2.

    Article  CAS  PubMed  Google Scholar 

  36. von Smekal A. The potential of cardio-computed tomography. Multislice CT: a practical guide. Proceedings of the 5th International Somatom CT User Conference, Zurich, June 2000.

    Google Scholar 

  37. Nieman K, et al. Coronary angiography with multi-slice computed tomography. Lancet. 2001;357(9256):599–603.

    Article  CAS  PubMed  Google Scholar 

  38. Ropers D, et al. Investigation of aortocoronary artery bypass grafts by multislice spiral computed tomography with electrocardiographic-gated image reconstruction. Am J Cardiol. 2001;88(7):792–5.

    Article  CAS  PubMed  Google Scholar 

  39. Lee JH, et al. Prospective versus retrospective ECG-gated 64-detector coronary CT angiography for evaluation of coronary artery bypass graft patency: comparison of image quality, radiation dose and diagnostic accuracy. Int J Cardiovasc Imaging. 2011;27(5):657–67.

    Article  PubMed  Google Scholar 

  40. Stein PD, et al. Usefulness of 4-, 8-, and 16-slice computed tomography for detection of graft occlusion or patency after coronary artery bypass grafting. Am J Cardiol. 2005;96(12):1669–73.

    Article  PubMed  Google Scholar 

  41. Anders K, et al. Coronary artery bypass graft (CABG) patency: assessment with high-resolution submillimeter 16-slice multidetector-row computed tomography (MDCT) versus coronary angiography. Eur J Radiol. 2006;57(3):336–44.

    Article  PubMed  Google Scholar 

  42. Yamamoto M, et al. Noninvasive assessment of off-pump coronary artery bypass surgery by 16-channel multidetector-row computed tomography. Ann Thorac Surg. 2006;81(3):820–7.

    Article  PubMed  Google Scholar 

  43. Houslay ES, et al. Non-invasive assessment of coronary artery bypass graft patency using 16-slice computed tomography angiography. J Cardiothorac Surg. 2007;2:27.

    Article  PubMed  PubMed Central  Google Scholar 

  44. Tochii M, et al. Accuracy of 64-slice multidetector computed tomography for diseased coronary artery graft detection. Ann Thorac Surg. 2010;89(6):1906–11.

    Article  PubMed  Google Scholar 

  45. Chan M, et al. A systematic review and meta-analysis of multidetector computed tomography in the assessment of coronary artery bypass grafts. Int J Cardiol. 2016;221:898–905.

    Article  PubMed  Google Scholar 

  46. Ueyama K, et al. Evaluation of coronary artery bypass grafts using helical scan computed tomography. Catheter Cardiovasc Interv. 1999;46(3):322–6.

    Article  CAS  PubMed  Google Scholar 

  47. Marano R, et al. Non-invasive assessment of coronary artery bypass graft with retrospectively ECG-gated four-row multi-detector spiral computed tomography. Eur Radiol. 2004;14(8):1353–62.

    Article  PubMed  Google Scholar 

  48. Romagnoli A, et al. Diagnostic accuracy of 64-slice CT in evaluating coronary artery bypass grafts and of the native coronary arteries. Radiol Med. 2010;115(8):1167–78.

    Article  CAS  PubMed  Google Scholar 

  49. de Graaf FR, et al. Diagnostic performance of 320-slice multidetector computed tomography coronary angiography in patients after coronary artery bypass grafting. Eur Radiol. 2011;21(11):2285–96.

    Article  PubMed  PubMed Central  Google Scholar 

  50. Fitzgibbon GM, et al. Coronary bypass graft fate and patient outcome: angiographic follow-up of 5,065 grafts related to survival and reoperation in 1,388 patients during 25 years. J Am Coll Cardiol. 1996;28(3):616–26.

    Article  CAS  PubMed  Google Scholar 

  51. Weintraub WS, et al. Frequency of repeat coronary bypass or coronary angioplasty after coronary artery bypass surgery using saphenous venous grafts. Am J Cardiol. 1994;73(2):103–12.

    Article  CAS  PubMed  Google Scholar 

  52. Zeff RH, et al. Internal mammary artery versus saphenous vein graft to the left anterior descending coronary artery: prospective randomized study with 10-year follow-up. Ann Thorac Surg. 1988;45(5):533–6.

    Article  CAS  PubMed  Google Scholar 

  53. Achouh P, et al. Reappraisal of a 20-year experience with the radial artery as a conduit for coronary bypass grafting. Eur J Cardiothorac Surg. 2012;41(1):87–92.

    Article  PubMed  Google Scholar 

  54. Javadzadegan H, Javadzadegan A, Mehdizadeh Baghbani J. Factors influencing mortality after bioprosthetic valve replacement; a midterm outcome. J Cardiovasc Thorac Res. 2013;5(4):163–5.

    PubMed  PubMed Central  Google Scholar 

  55. Ghanta RK, et al. Evolving trends of reoperative coronary artery bypass grafting: an analysis of the Society of Thoracic Surgeons Adult Cardiac Surgery Database. J Thorac Cardiovasc Surg. 2013;145(2):364–72.

    Article  PubMed  Google Scholar 

  56. Kaneko T, et al. Contemporary outcomes of repeat aortic valve replacement: a benchmark for transcatheter valve-in-valve procedures. Ann Thorac Surg. 2015;100(4):1298–304; discussion 1304.

    Article  PubMed  Google Scholar 

  57. Ghoreishi M, et al. Repeat sternotomy: no longer a risk factor in mitral valve surgical procedures. Ann Thorac Surg. 2013;96(4):1358–65.

    Article  PubMed  Google Scholar 

  58. Christenson JT, Schmuziger M, Simonet F. Reoperative coronary artery bypass procedures: risk factors for early mortality and late survival. Eur J Cardiothorac Surg. 1997;11(1):129–33.

    Article  CAS  PubMed  Google Scholar 

  59. Gasparovic H, et al. Three dimensional computed tomographic imaging in planning the surgical approach for redo cardiac surgery after coronary revascularization. Eur J Cardiothorac Surg. 2005;28(2):244–9.

    Article  PubMed  Google Scholar 

  60. Imran Hamid U, et al. Incidence and outcome of re-entry injury in redo cardiac surgery: benefits of preoperative planning. Eur J Cardiothorac Surg. 2015;47(5):819–23.

    Article  PubMed  Google Scholar 

  61. Kamdar AR, et al. Multidetector computed tomographic angiography in planning of reoperative cardiothoracic surgery. Ann Thorac Surg. 2008;85(4):1239–45.

    Article  PubMed  Google Scholar 

  62. Aviram G, et al. Open heart reoperations after coronary artery bypass grafting: the role of preoperative imaging with multidetector computed tomography. Isr Med Assoc J. 2009;11(8):465–9.

    PubMed  Google Scholar 

  63. den Harder AM, et al. Effect of computed tomography before cardiac surgery on surgical strategy, mortality and stroke. Eur J Radiol. 2016;85(4):744–50.

    Article  Google Scholar 

  64. Gada H, Desai MY, Marwick TH. Cost-effectiveness of computed tomographic angiography before reoperative coronary artery bypass grafting: a decision-analytic model. Circ Cardiovasc Qual Outcomes. 2012;5(5):705–10.

    Article  PubMed  Google Scholar 

  65. Oda S, et al. Cardiac CT for planning redo cardiac surgery: effect of knowledge-based iterative model reconstruction on image quality. Eur Radiol. 2015;25(1):58–64.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Surgery, Division of Cardiothoracic Surgery, Medical University of South Carolina, Charleston, SC, USA

    Lloyd M. Felmly

Authors
  1. Lloyd M. Felmly
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Lloyd M. Felmly .

Editor information

Editors and Affiliations

  1. Department of Radiology, Center for Advanced Imaging Research (CAIR), Medical University of South Carolina, Charleston, SC, USA

    U. Joseph Schoepf

Rights and permissions

Reprints and permissions

Copyright information

© 2019 Humana Press

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Felmly, L.M. (2019). Multidetector CT Angiography for Coronary Bypass Graft Assessment and Reoperative Cardiac Surgery. In: Schoepf, U. (eds) CT of the Heart. Contemporary Medical Imaging. Humana, Totowa, NJ. https://doi.org/10.1007/978-1-60327-237-7_33

Download citation

  • DOI: https://doi.org/10.1007/978-1-60327-237-7_33

  • Published:

  • Publisher Name: Humana, Totowa, NJ

  • Print ISBN: 978-1-60327-236-0

  • Online ISBN: 978-1-60327-237-7

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation