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Published on: November 24, 2014
Evaluation of graft patency during minimally invasive coronary artery bypass grafting with Doppler flow analysis
J C Lin1, D L Fisher, M F Szwerc
1Department of Cardiothoracic Surgery, Allegheny General Hospital, Pittsburgh, Pennsylvania 15212, USA.
Insights
Objective analysis of graft flow using Doppler is crucial for 100% early graft patency in minimally invasive direct coronary artery bypass. This safe and accurate method ensures optimal outcomes for coronary artery bypass surgery.
Area of Science:
- Cardiovascular Surgery
- Medical Imaging
- Vascular Surgery
Background:
- Intraoperative graft patency assessment is vital for minimally invasive direct coronary artery bypass (MIDCAB).
- This study evaluates angiography and Doppler methods for graft analysis during MIDCAB.
- Long-term outcomes in a patient cohort are presented.
Purpose of the Study:
- To compare angiography and Doppler methods for assessing graft patency during MIDCAB.
- To determine the accuracy of Doppler analysis in identifying graft failures.
- To report long-term patient outcomes following MIDCAB with objective graft assessment.
Main Methods:
- 35 patients underwent elective MIDCAB, with left internal mammary artery to left anterior descending anastomosis.
- Intraoperative graft patency was assessed using selective left internal mammary artery angiography.
- Doppler flow analysis was performed using a 1-mm, 20-MHz Doppler probe.
Main Results:
- Immediate perfect patency with brisk flow was observed in 91% of patients.
- Doppler analysis demonstrated 100% accuracy in confirming graft patency and detecting failed grafts.
- All abnormal grafts were revised, achieving 100% early patency. No late deaths occurred over 2 years.
Conclusions:
- Objective intraoperative graft flow analysis is essential for 100% early patency in MIDCAB.
- Doppler analysis is the preferred method due to its safety, accuracy, and speed.
- Successful graft revision led to excellent short- and long-term patient outcomes.
Background:
An objective method for determining intraoperative graft patency is an essential part of minimally invasive direct coronary artery bypass. This study compares angiography and Doppler methods for graft analysis during minimally invasive direct coronary artery bypass and presents long-term outcome in a cohort of patients.
Methods:
Between March and October 1997, 35 patients had elective minimally invasive direct coronary artery bypass procedures in which the left internal mammary artery was anastomosed to the left anterior descending coronary artery. Immediate graft patency was determined with intraoperative angiography using selective injection of the left internal mammary artery from a femoral approach and with Doppler flow analysis using a 1-mm, 20-MHz Doppler probe placed directly on the graft.
Results:
There was immediate perfect patency with brisk flow in 91% of patients (32 of 35). A normal Doppler study, defined as a diastolic predominant pattern with a diastolic flow velocity of greater than 15 cm/second, was found in all patients with normal angiograms. All patients with abnormal angiograms also had abnormal Doppler flow. Thus, Doppler analysis was 100% accurate for confirming graft patency and for detecting failed grafts. All abnormal grafts were successfully revised, which allowed 100% early patency. Operative mortality was 2.8% (1 of 35) and there have been no late deaths at a follow-up of more than 2 years. One patient required angioplasty of the anastomosis (1 of 34, 2.9%), but none have required subsequent surgical intervention.
Conclusions:
Objective analysis of graft flow in the operating room is necessary to achieve 100% early graft patency with minimally invasive direct coronary artery bypass operations. Doppler analysis is the preferred initial method, because it is safe, accurate, and rapid.
