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Intraoperative graft verification in coronary surgery
Gabriele Di Giammarco1, Daniele Marinelli, Massimiliano Foschi
1Department of Cardiac Surgery, University 'G. D'Annunzio', Chieti, Italy.
Journal of Cardiovascular Medicine (Hagerstown, Md.)
|July 2, 2016
Summary
Transit-time flow measurement (TTFM) improves coronary surgery graft assessment using Mean Graft Flow (MGF) and Pulsatility Index (PI). Adding high-resolution ultrasound enhances diagnostic accuracy for better patient outcomes.
Area of Science:
- Cardiovascular Surgery
- Medical Imaging
- Surgical Technology
Background:
- Transit-time flow measurement (TTFM) is a standard intraoperative technique for assessing coronary artery bypass graft (CABG) function.
- Established parameters like Mean Graft Flow (MGF) and Pulsatility Index (PI) have known cutoffs predicting clinical outcomes and postoperative angiography results.
- Limitations in diagnostic accuracy of TTFM necessitate improvements for reliable intraoperative graft evaluation.
Purpose of the Study:
- To evaluate the efficacy of combining TTFM with high-resolution epicardic coronary ultrasound for intraoperative coronary graft assessment.
- To improve the diagnostic accuracy of intraoperative graft verification methods.
- To provide a comprehensive review and a potential roadmap for intraoperative graft assessment.
Main Methods:
- Intraoperative graft verification using TTFM, measuring Mean Graft Flow (MGF), Pulsatility Index (PI), and Insufficiency Ratio (%BF).
- Integration of a high-resolution epicardic coronary ultrasound module for 2D imaging and color-flow mapping of grafts and anastomoses.
- Systematic literature review on intraoperative graft verification methods.
Main Results:
- Specific MGF and PI cutoffs are identified as predictors of poor 1-year clinical outcomes and correlate with postoperative angiography findings.
- High-resolution ultrasound provides accurate morphological evaluation of grafts and anastomoses, complementing flow data.
- The combined approach aims for enhanced diagnostic accuracy compared to TTFM alone.
Conclusions:
- Combining TTFM with high-resolution epicardic ultrasound offers a more accurate and comprehensive method for intraoperative coronary graft assessment.
- This integrated approach addresses the need for objective, reliable, and minimally invasive graft verification in coronary surgery.
- The study proposes a roadmap for implementing and utilizing advanced intraoperative graft assessment techniques.
