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Graft revision after transit time flow measurement in off-pump coronary artery bypass grafting
G D'Ancona1, H L Karamanoukian, M Ricci
1Center for Minimally Invasive Cardio-thoracic Surgery, Kaleida Health Systems and the State University of New York at Buffalo, 14203, USA.
Insights
Transit time flow measurement (TTFM) effectively predicts coronary graft patency after coronary artery bypass grafting (CABG). This technique allows for timely correction of graft abnormalities before chest closure, improving outcomes.
Area of Science:
- Cardiovascular Surgery
- Medical Devices
- Surgical Outcomes
Background:
- Coronary artery bypass grafting (CABG) is a critical procedure for treating coronary artery disease.
- Ensuring graft patency is paramount for successful CABG outcomes.
- Assessing graft status intraoperatively remains a challenge.
Purpose of the Study:
- To prospectively evaluate the utility of transit time flow measurement (TTFM) in predicting coronary graft patency.
- To determine if TTFM can identify grafts requiring revision during CABG surgery.
- To assess the impact of TTFM-guided revisions on graft function and patient outcomes.
Main Methods:
- Prospective evaluation of TTFM in 409 patients undergoing off-pump CABG.
- 1145 coronary grafts were assessed using TTFM.
- Grafts identified with abnormal flow patterns underwent intraoperative revision.
Main Results:
- 3.2% of grafts (37/1145) required revision due to low or abnormal flow patterns identified by TTFM.
- Revisions corrected flow abnormalities in 91.9% of cases.
- Postoperative complications were low (3% stroke, 3% MI, 3% wound infection, 3% prolonged ventilation).
Conclusions:
- TTFM is a valuable tool for assessing coronary graft status immediately after CABG.
- Accurate interpretation of TTFM flow patterns enables intraoperative correction of graft abnormalities.
- This proactive approach can potentially improve surgical success rates and reduce complications.
Objective:
To determine whether coronary graft patency can be predicted by transit time flow measurement (TTFM).
Methods:
From May 1 1997 to December 31 1998, TTFM was prospectively evaluated in 409 patients undergoing coronary artery bypass grafting (CABG) without cardiopulmonary bypass (CPB). All grafts (1145) were tested with TTFM.
Results:
Thirty-seven out of 1145 grafts (3.2%) were revised in 33 patients (7.6%). In six cases (18.1%) use of CPB was necessary during revision due to hemodynamic instability. The remaining patients underwent revision off-pump. Thirty-four grafts (91.9%) were revised for both low flow and abnormal flow curve patterns. Findings at revision included: thrombosis of the anastomosis (n=6), stenosis at the toe or heel of the anastomosis (n=8), coronary flap or dissection (n=5), dissection of the internal mammary artery (n=5), graft kinking (n=4), flap at proximal anastomosis (n=1), coronary stenosis distal to the graft (n=3), and no findings (n=2). After revision all flow values and flow patterns improved. Although three additional grafts (8.1%) were revised for low flow (<7 ml/min) despite normal flow patterns, there were no findings at revision and flow values and curves remained unchanged after revision. Postoperatively, one patient developed a stroke (3%), one had an acute myocardial infarction (MI) (3%), one had a sternal wound infection (3%), and one required prolonged ventilatory support (3%).
Conclusion:
Evaluation of TTFM is valuable in determining the status of a coronary graft after CABG. Correct interpretation of flow patterns allows for correction of abnormalities prior to chest closure.