Epicardial 10-MHz ultrasound in off-pump coronary bypass surgery: A clinical feasibility study using a minitransducer

Abstract

Objective: In off-pump coronary artery bypass surgery, both plaque and calcifications and torrential back flow from side branches in the isolated coronary segment may hamper coronary anastomosis suturing. The epicardial application of an ultrasonographic minitransducer with color Doppler scanning modality was studied in off-pump coronary surgery to detect septal perforating side branches; to assess the location, size, and quality of the coronary vessel; and to visualize the anastomotic orifice before chest closure. Methods: Thirteen patients were selected for multivessel off-pump bypass. The investigation was limited to the left anterior descending coronary artery. The anastomotic target site was chosen on preoperative and intraoperative findings. The conventionally designated site was scanned with a novel 10-MHz ultrasonographic miniprobe (15 x 6 x 9 mm) that fitted in between the cardiac stabilizer pods. Results: In 11 of the 13 cases, the course of the left anterior descending coronary artery could be properly identified. In 3 cases detection of perforating side branches caused a change in anastomotic site. A sufficiently dry field was obtained in all 13 cases. In 11 cases the anastomotic orifice was adequately visualized. Conclusion: During off-pump coronary surgery, 10-MHz ultrasonographic images from a minitransducer aided in the intraoperative choice of anastomotic site.