Boston - American Association for Thoracic Surgery

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89 TH ANNUAL MEETING MAY 9–MAY 13, 2009BOSTON, MASSACHUSETTSL2. The Graft Imaging to Improve Patency (GRIIP) Trial ResultsSteve Singh, Nimesh Desai, † Genta Chikazawa, Hiroshi Tsuneyoshi,Visal Pen, Jessica Vincent, Jennifer Ku, Fuad Moussa, Gideon Cohen,George Christakis, * Stephen E. Fremes *Sunnybrook Health Sciences Centre, Toronto, ON, CanadaOBJECTIVE: The primary objective was to determine if intra-operative graftassessment, with criteria for graft revision, can decrease the proportion of patientswith ≥1 total (100%) graft occlusions 1 year post-operatively. Secondary objectiveswere to determine if intra-operative graft flow assessment can decrease: i) the proportionof patients with ≥1 graft stenoses (50–99%); ii) the proportion of patientswith complete graft occlusion or stenosis; and iii) the frequency of perioperativeand 1 year major adverse cardiac events (MACE).METHODS: This a single-centre, randomized, single-blinded controlled clinicaltrial. Patients were randomized to receive intra-operative graft patency assessmentusing indocyanine green fluorescent angiography and transit-time flowmetry andgraft revision according to specific criteria, or serve as controls receiving standardintra-operative management. Patients underwent conventional X-ray or 64 sliceCT angiography post-operatively.* AATS Member† Resident Traveling Fellowship 2006Imaging(n = 43)Controls(n = 41)RR(95% CI) p-valueTotal # grafts 125 120PRIMARY ENDPOINTGraft occlusions, No. (%) 15/125 (12.0) 16/120 (13.3) 0.90 (0.47–1.74) 0.75Saphenous vein grafts, No. (%) 15/59 (25.4) 14/63 (22.2) 1.14 (0.61-2.16) 0.68Arterial grafts, No. (%) 0/66 (0) 2/57 (3.5) 0.19 (0.0–3.90) 0.28Patients with ≥1 graft occlusion, 11/43 (25.6) 13/41 (31.7) 0.81 (0.41–1.59) 0.54No. (%)SECONDARY ENDPOINTSGrafts with >50% stenosis, No. (%) 4/125 (3.2) 5/120 (4.2) 0.77 (0.21–2.79) 0.69Saphenous vein grafts, No. (%) 1/59 (1.7) 4/63 (6.3) 0.27 (0.03–2.32) 0.23Arterial grafts, No. (%) 3/66 (4.5) 1/57 (1.8) 0.86 (0.18–4.11) 0.85Patients with ≥ 1 graft with 3/43 (7.0) 5/41 (12.2) 0.56 (0.14–2.19) 0.40>50% stenosis, No. (%)Grafts with > 50% stenosis or 19/125 (15.2) 21/120 (17.5) 0.87 (0.49–1.53) 0.63occlusion, No. (%)Saphenous vein grafts, No. (%) 16/59 (27.1) 18/63 (28.6) 0.95 (0.54–1.68) 0.86Arterial grafts, No. (%) 3/66 (4.5) 3/57 (5.3) 0.86 (0.18–4.11) 0.85Patients with ≥1 graft with >50% 13/43 (30.2) 17/41 (41.5) 0.73 (0.41–1.30) 0.29stenosis or occlusion, No. (%)56
AMERICAN ASSOCIATION FOR THORACIC SURGERYRESULTS: Between September 2005 and August 2008, 156 patients undergoingisolated CABG surgery were enroled (Imaging n = 76, Control n = 76). The groupswere similar in terms of demographic and angiographic characteristics. On-pumpCABG was performed in all but 12 patients. Operative, cross clamp and cardiopulmonarybypass times were all non-significantly longer in the Imaging patients.The number of grafts constructed in the 2 groups were similar (Imaging: 3.0 ± 0.7grafts/pt; Control: 3.0 ± 0.6 grafts/pt). There were no significant differencesbetween the 2 groups in the incidence of perioperative events. Overall, the 1 yearMACE (death, MI, PCI, redo CABG) was similar in the Imaging (12.7%) and theControl (9.4%) patients (p = 0.55). Post-operative X-ray (n = 23) or CT angiography(n = 61) was performed in 43 Imaging patients at 9.6 ± 8.7 months following surgeryand 41 Control patients at 11.5 ± 8.9 months post-operatively. Graft occlusionresults are presented in the Table. The proportion of patients with ≥1 graft occlusionswas similar between the 2 groups [25.6% in the Imaging group (11/43patients) and 31.7% in the Controls (13/41 patients)] as was the incidence of theother graft patency endpoints. The incidence of saphenous vein graft occlusionwas high in both the Imaging and Control patients.SUNDAYAfternoonCONCLUSION: Routine intra-operative graft assessment is safe, but does notlead to a marked improvement in graft patency 1 year post-CABG. The incidenceof saphenous vein graft failure is high even with routine intra-operative graftsurveillance.57
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AATS FUTURE MEETINGSMay 1-5, 2010Me
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Boston - American Association for Thoracic Surgery

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