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Published on: November 24, 2014
Intra-operative graft blood flow measurements for composite and sequential coronary artery bypass grafting
Jessica Forcillo1, Nicolas Noiseux, Marc-Jacques Dubois
11 Division of Cardiac Surgery and Cardiology, University of Montreal Hospital Center (CHUM), CHUM Research Center (CRCHUM), Montreal, Quebec - Canada.
Insights
Transit-time flowmetry (TTF) assessed coronary artery bypass graft (CABG) quality. Off-pump CABG with sequential vein grafts showed lower TTF, but early outcomes were similar to on-pump procedures.
Area of Science:
- Cardiovascular Surgery
- Surgical Technology
- Graft Assessment
Background:
- Transit-time flowmetry (TTF) is utilized for intraoperative assessment of coronary artery bypass graft (CABG) anastomotic quality.
- Evaluating TTF for both on-pump and off-pump CABG procedures is crucial for understanding graft performance.
Purpose of the Study:
- To compare intraoperative graft TTF and early postoperative outcomes between on-pump and off-pump coronary artery bypass grafting (CABG).
Main Methods:
- A total of 521 distal graft flows were assessed using TTF in 253 patients undergoing primary isolated CABG.
- Data were analyzed using multilevel models, accounting for surgeon and patient-level clustering.
- Comparison between on-pump and off-pump procedures, including sequential vein grafts, was performed.
Main Results:
- Off-pump surgery was associated with lower intra-operative TTF in sequential vein grafts compared to on-pump.
- Independent predictors of lower TTF included female gender and off-pump surgery.
- On-pump patients required more inotropic support (milrinone or dobutamine) postoperatively.
Conclusions:
- Sequential vein grafts in off-pump CABG demonstrated lower intra-operative TTF measurements.
- Despite lower TTF, off-pump CABG patients experienced comparable short-term outcomes to on-pump patients.
Objectives:
Intraoperative assessment of coronary artery bypass grafts (CABG) anastomotic quality can be performed using transit-time flowmetry (TTF). The aim of this study was to compare on- versus off-pump coronary graft TTF and early postoperative outcomes.
Materials And Methods:
Between January 2009 and January 2010, 521 distal graft flows were assessed using TTF measurements in 253 consecutive patients undergoing primary isolated CABG surgery. Data were analyzed using multilevel models accounting for clustering among surgeons and grafts performed in the same patient.
Results:
Mean age was 66 ± 10 years and 22% were female (n = 55) with 34% diabetics (n = 86) and 40% preoperative myocardial infarction (MI) (n = 101). The surgeries were performed off-pump in 67% (n = 170) with sequential vein grafts in 57% (n = 144) of patients. Off-pump patients had higher pre-operative left ventricular ejection fractions (LVEF), fewer urgent surgeries, fewer distal anastomoses, and fewer sequential vein grafts (all p<0.001). Intra-operative coronary graft TTF measurements were lower in sequential vein grafts performed off-pump versus on-pump. More patients in the on-pump group needed milrinone or dobutamine 24-48 h postoperatively (p = 0.005). Independent predictors of lower TTF included female gender and off-pump surgery, whereas predictors of better TTF were preoperative MI, larger coronary diameter at the site of the distal anastomosis, and sequential vein grafting.
Conclusions:
Lower intra-operative TTF measurements were found in sequential vein grafts in off-pump CABG. However, off-pump patients experienced similar short-term outcomes compared to on-pump patients.
