Integrating coronary angiography into the cardiac operating room

Abstract

In coronary artery surgery, particularly when new surgical techniques like beating heart surgery are introduced, quality control is essential to achieve excellent clinical results. During the period 1996 to 2005, 233 patients having coronary artery surgery at Rikshospitalet were included in the study. The aims of the thesis were to evaluate the role of coronary angiography in the cardiac operating room, and to compare coronary angiography with transit time flow measurement and epicardial ultrasonography in graft quality assessment. Whether intraoperative imaging could improve the results of coronary artery fistula surgery was also assessed. Coronary angiography, transit time flow measurements and epicardial ultrasonography were performed intraoperatively; coronary angiography was also performed during follow-up. Intraoperative angiography was found to have a role for quality assessment in the cardiac operating room. Intraoperative angiography can save a potential number of grafts that otherwise would have occluded, and may increase the success rate of surgical closure of coronary artery fistulas. Angiography was superior to transit time flow measurement and epicardial ultrasonography in detecting grafts in need of revision. In the future, surgery may be performed in an augmented reality with a more active use of the total imaging information during the surgical procedure. To evaluate the role of angiograms obtained intraoperatively is therefore of importance.