T-grafts in coronary surgery: Comparison of arterial coronary angiography and multi slice computed tomography

Objectives: Main focus of our study was to compare the results and value of angiography and multi slice computed tomography (MSCT) after coronary artery bypass grafting (CABG) using complex conduit combinations. Generally, MSCT is considered to be less sensitive and less specific regarding bypass patency, but has the considerable advantage of being a less invasive. Material and methods: Twenty six patients underwent elective coronary surgery. In all patients, we utilized a T-Graft consisting of a free right internal thoracic or radial artery centrally implanted into the left internal thoracic artery. Postoperative angiography and MSCT including volume rendering were undertaken on postoperative day 8. Angiography and MSCT were interpreted separately by two different investigators and then compared. Results: Ninety one distal anastomoses by use of 61 grafts were performed in 26 patients with an average number of 3.5 peripheral anastomoses. Angiography showed a bypass graft patency rate of 90.2% (55/61). In angiography, the patency rate of anastomoses measured 91.2% (83/91). Bypass patency rate by MSCT measured was 90.2% (56/61) and the patency rate of anastomoses 93.4% (85/91). Based on these results MSCT showed a sensitivity of 97.6%. Specificity was 66.7% and predictive accuracy measured 97.6%. Conclusion: MSCT is suitable as control after CABG regarding bypass graft patency, especially for complex conduit combinations such as the T-graft. It allows a reliable visualization of patent or occluded bypass grafts and is a less invasive method compared to angiography. The ability to quantify stenosis is restricted.