Integrating coronary angiography into the cardiac operating room
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AbstractIn 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.
List of papers. This thesis is based on the following papers, which will be referred to by their Roman numerals:
I. Hol PK, Fosse E, Lundblad R, Nitter-Hauge S, Due-Tønnessen P, Vatne K, Smith HJ. The importance of intraoperative angiographic findings for predicting long-term patency in coronary artery bypass operations. Ann Thorac Surg 2002 Mar;7(3):813-8 Abstract.
II. Hol PK, Lingaas PS, Lundblad R, Rein KA, Vatne K, Smith HJ, Nitter-Hauge S, Fosse E. Intraoperative angiography leads to graft revision in coronary artery bypass surgery. Ann Thorac Surg 2004 Aug;7(2):502-5 Abstract.
III. Hol PK, Fosse E, Mørk BE, Lundblad R, Rein KA, Lingaas PS, Geiran O, Svennevig JL, Tonnessen TI, Nitter-Hauge S, Due-Tonnessen P, Vatne K, Smith HJ. Graft control by transit time flow measurement and intraoperative angiography in coronary artery bypass surgery. Heart Surg Forum 2001;4(3):254-7 Abstract.
IV. Hol PK, Andersen K, Skulstad H, Halvorsen PS, Lingaas PS, Andersen R, Bergsland J, Fosse E. Epicardial ultrasonography - a potential method for intraoperative quality assessment of coronary bypass anastomoses? Accepted for publication in Ann Thorac Surg 2007 Sep;84(3):801-7. Ann Thorac Surg 2007 Sep;84(3):801-7. Abstract.
V. Hol PK, Geiran O, Andersen K, Vatne K, Offstad J, Svennevig JL, Fosse E. Improvement of coronary artery fistula surgery by intraoperative imaging. Ann Thorac Surg 2004 Dec;78(6):2193-5 Abstract.