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Published on: March 27, 2018
Severe impairment of graft flow without electrocardiographic changes during coronary artery bypass grafting
1Department of Cardiothoracic Surgery, Gentofte Hospital, University of Copenhagen, Denmark.
Insights
Transit-time flowmetry effectively detects early graft failure after coronary artery bypass grafting. This method is crucial as electrocardiographic changes are insufficient to identify bypass graft issues, ensuring patient safety.
Area of Science:
- Cardiovascular Surgery
- Medical Device Technology
- Surgical Outcomes
Background:
- Early graft occlusion following coronary artery bypass grafting (CABG) can lead to severe complications.
- Routine monitoring for graft patency is essential to prevent adverse events.
Purpose of the Study:
- To evaluate the efficacy of transit-time flowmetry in detecting early graft failure after CABG.
- To highlight the limitations of electrocardiographic (ECG) monitoring in identifying such failures.
Main Methods:
- The study involved routine use of transit-time flowmetry after cardiopulmonary bypass termination in CABG patients.
- Five cases of early graft failure were identified and analyzed.
Main Results:
- Transit-time flowmetry detected five instances of early graft failure.
- Electrocardiographic changes were observed in only one patient, and other clinical signs of graft failure were absent.
- Identified causes included graft tagging, internal mammary artery rotation, and vein graft kinking.
- Post-correction flowmetry confirmed normal flow rates.
Conclusions:
- Routine transit-time flowmetry is recommended for quality control after CABG to ensure bypass graft patency.
- Electrocardiography alone is insufficient for assessing bypass graft flow and integrity.
Abstract:
Early graft occlusion after coronary artery bypass grafting may have deleterious consequences. We routinely use transit-time flowmetry after termination of cardiopulmonary bypass, and we report five cases of early graft failure detected by the flowmeter. Electrocardiographic (ECG) changes were seen in only one of these five cases, and none of the patients had low cardiac output or other signs of graft failure at the end of the operation. The cause of graft failure was tagging in one case, rotation of internal mammary artery grafts in two and kinking of vein grafts in two cases. All errors were corrected, and control flowmetry showed normal flow rates after correction. Flowmetry takes less than 10 min, even with multiple bypass grafts. Based on our results, we advocate routine quality control with flowmetry after termination of cardiopulmonary bypass, since ECG changes are insufficient as checks of flow in bypass grafts.
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