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Evaluation of a Novel Laser-assisted Coronary Anastomotic Connector - the Trinity Clip - in a Porcine Off-pump Bypass Model
Published on: November 24, 2014
[Ultrasonic doppler flowmetry in intraoperative diagnosis of coronary bypass grafts incompetence]
Insights
Graft occlusion after coronary bypass surgery is common, occurring in up to 30% within a year. Ultrasound Doppler flowmetry can assess graft quality and potentially reduce bypass graft failure by improving surgical technique control.
Area of Science:
- Cardiovascular Surgery
- Medical Imaging
- Vascular Physiology
Background:
- Coronary bypass graft occlusion is a significant complication, with rates ranging from 4-12% during surgery to 30% within the first year post-discharge.
- Graft incompetence often stems from surgical technique errors, highlighting the need for improved quality control in coronary bypass grafting procedures.
Purpose of the Study:
- To assess the efficacy of ultrasound Doppler flowmetry in evaluating the quality of composite bypass grafts during coronary artery bypass grafting (CABG).
- To determine the relationship between peripheral resistance before and after aortic clamp removal to predict graft patency and function.
Main Methods:
- Employed ultrasound Doppler flowmetry on 64 composite bypass grafts under conditions of artificial circulation and arterial clamping.
- Measured key blood flow parameters: pulsatility index (PI), mean volumetric blood flow velocity (Qmean), and diastolic filling percentage (DF).
- Statistically analyzed data to determine the dependence of peripheral resistance (PI) on clamp status (before and after aortic clamp removal).
Main Results:
- Established mean values for pulsatility index (PI), mean volumetric blood flow velocity (Qmean), and diastolic filling (DF) in assessed bypass grafts.
- Identified a correlation between peripheral resistance (PI) measured before aortic clamp removal and after termination of extracorporeal circulation.
Conclusions:
- Ultrasound Doppler flowmetry provides valuable parameters for assessing bypass graft quality during CABG.
- Monitoring peripheral resistance (PI) before and after clamp removal can aid in the intraoperative assessment of graft performance and potentially reduce early graft failure.
Abstract:
According to the findings of many authors, occlusion of bypass grafts may develop as early as during surgery in 4-12% of patients. At discharge from hospital this index may reach 5-20%, increasing to 30% within the first year. Incompetence of bypass grafts is in many cases a consequence of errors in surgical technique and may therefore be decreased by means of improving the control over quality of coronary bypass grafting. Using the method of ultrasound Doppler flowmetry in the conditions of artificial circulation and clamped artery, we assessed a total of 64 composite bypass grafts. Blood flow was assessed by such parameters as the pulsatility index (PI), mean volumetric blood flow velocity (Qmean), and percentage of diastolic volumetric filling (DF). The obtained results were statistically processed. The mean values of blood flow parameters were obtained, followed by determining dependence between peripheral resistance (PI) prior to removal of the clamp from the aorta and peripheral resistance (PI) measured after termination of extracorporeal circulation.
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