Transit-time flow measurement is essential in coronary artery bypass grafting

Patent bypass grafts are fundamental to successful coronary artery bypass grafting. Intraoperative flow measurement through newly constructed grafts is a test of patency. We studied the use of transit-time flow measurement to determine its ability to detect technical errors in grafts, to measure the mean flow norms for Asian patients, and to compare arterial and vein grafts.

From January 1, 2001, to June 30, 2002, 116 patients underwent isolated primary coronary artery bypass grafting. Sixty-seven patients underwent conventional coronary artery bypass grafting and 49 patients underwent off-pump coronary artery bypass grafting. There were 125 arterial and 197 vein grafts. Transit-time flow measurement was carried out on all completed grafts. Graft patency was assessed using flow curves, mean flow, and pulsatility index. Average of mean flows was calculated to determine mean flow norms. Arterial and vein grafts were compared by statistical analysis between the variables mean flow and pulsatility index.

In 6 patients with seven grafts, intraoperative graft assessment detected technical errors, which were corrected. Average mean flow was 37.4 +/- 23.5 mL/min for left anterior descending coronary artery-to-left internal mammary artery grafts, and values ranging from 21.2 to 36.0 mL/min for the rest. There were no statistically significant differences in mean flow or pulsatility index between arterial and vein grafts.

Transit-time flow measurement enables technical problems to be diagnosed accurately, allowing prompt revision of grafts. It should be mandatory in coronary artery bypass grafting to improve surgical outcomes.