Intraoperative hemodynamic assessment of gastroepiploic artery and saphenous vein bypass grafts: a comparative study
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Published on: November 19, 2019
Y A Louagie1, J Jamart, M Buche
1Division of Cardiovascular and Thoracic Surgery, Université Hospital of Mont-Yvoir, Belgium.
Insights
The right gastroepiploic artery and saphenous vein show similar blood flow in bypass surgery. However, the right gastroepiploic artery exhibits a distinct waveform with higher peak velocities, indicating potential differences in graft performance.
Area of Science:
- Cardiovascular Surgery
- Vascular Biology
- Biomedical Engineering
Background:
- Coronary artery bypass grafting (CABG) is a critical procedure for treating coronary artery disease.
- Graft selection, including the use of the right gastroepiploic artery (RGEA) and saphenous vein (SV), significantly impacts surgical outcomes.
- Understanding the hemodynamic characteristics of different conduits is essential for optimizing graft patency and patient recovery.
Purpose of the Study:
- To compare the blood flow characteristics of RGEA and SV conduits used in coronary artery bypass grafting.
- To evaluate hemodynamic parameters such as flow rate and velocity profiles in both graft types.
- To determine if there are significant differences in blood flow between RGEA and SV grafts implanted in the same coronary territory.
Main Methods:
- A consecutive series of 97 patients undergoing CABG were included, with 52 receiving RGEA grafts and 45 receiving SV grafts.
- Blood flow and velocity profiles were measured using an 8-MHz pulsed-wave Doppler ultrasound flowmeter.
- Measurements were taken at two key time points: after cessation of cardiopulmonary bypass and before chest closure.
Main Results:
- No significant differences in overall blood flow (mL/min) were observed between RGEA and SV grafts at either measurement point (P = .08 and P = .10, respectively).
- Mean trace velocities were comparable between the two graft types (P = .80 and P = .22).
- Peak systolic velocities were significantly higher in RGEA grafts compared to SV grafts (P < .001 at both time points).
Conclusions:
- RGEA and SV grafts demonstrate comparable blood flow rates when implanted into similar coronary beds.
- The RGEA graft waveform is characterized by wider spectral dispersion and higher peak systolic velocities.
- These findings suggest that while flow volume is similar, the dynamic flow characteristics differ between RGEA and SV conduits.
Objective:
Blood flow characteristics of right gastroepiploic artery and saphenous vein conduits were compared during bypass surgery.
Methods:
This study is based on a consecutive series of 97 patients undergoing a bypass graft to the right coronary artery, posterior descending artery, or posterolateral branch using either a pediculated right gastroepiploic artery (n = 52) or a saphenous vein (n = 45) bypass graft. Flows and velocity profiles were measured with an 8-MHz pulsed-wave Doppler ultrasound flowmeter. Thorough flow measurements were made (1) after cessation of cardiopulmonary bypass and (2) before chest closure.
Results:
At the end of cardiopulmonary bypass, flow in the right gastroepiploic artery (59. 0 +/- 6.7 mL/min) did not differ (P =.08) from flow in the saphenous vein (46.1 +/- 2.7 mL/min). Mean trace velocity was 11.9 +/- 0.7 cm/s in the right gastroepiploic artery and 11.6 +/- 0.8 cm/s in the saphenous vein (P =.80), but peak systolic velocity was 29.4 +/- 1.2 cm/s for the right gastroepiploic artery and 23.1 +/- 1.3 cm/s for the saphenous vein (P <.001). Likewise, before chest closure, flow was 57.1 +/- 4.7 mL/min in the right gastroepiploic artery and 46.5 +/- 4.0 mL/min in the saphenous vein (P =.10), mean velocity was 12. 9 +/- 0.7 and 11.6 +/- 0.8 cm/s, respectively (P = .22), and systolic peak velocity was 30.0 +/- 1.2 and 22.3 +/- 1.2 cm/s, respectively (P < .001).
Conclusions:
There were no flow differences between right gastroepiploic artery and saphenous vein grafts implanted into the same coronary bed in comparable groups of patients. Waveform shape of the right gastroepiploic artery grafts was characterized by a wider spectral dispersion resulting in a higher maximal frequency.
