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Published on: November 24, 2014
Techniques for intraoperative graft assessment in coronary artery bypass surgery
Lucas B Ohmes1, Antonino Di Franco2, Gabriele Di Giammarco3
1Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, New York, USA.
Insights
Ensuring early graft patency after coronary artery bypass surgery is crucial. Intraoperative graft assessment using techniques like transit time flowmetry (TTFM) and ultrasonography can identify issues, reducing early graft failure.
Area of Science:
- Cardiovascular Surgery
- Medical Imaging
- Vascular Biology
Background:
- Early graft patency is critical for reducing morbidity and mortality after coronary artery bypass surgery (CABG).
- Graft failure can result from intimal hyperplasia, atherosclerosis, or surgical errors, necessitating intraoperative evaluation.
- Current intraoperative graft assessment methods have limitations, impacting their widespread adoption.
Purpose of the Study:
- To review and discuss available intraoperative techniques for assessing coronary artery bypass grafts.
- To highlight the diagnostic yield of combined transit time flowmetry (TTFM) and epicardial ultrasonography.
- To examine the potential of fluorescence imaging for graft assessment.
Main Methods:
- Literature review of intraoperative graft assessment techniques for CABG.
- Discussion of transit time flowmetry (TTFM) and its current utilization rates.
- Evaluation of high-resolution epicardial ultrasonography and fluorescence imaging in graft assessment.
Main Results:
- Transit time flowmetry (TTFM) is underutilized by cardiac surgeons despite its importance.
- Combining TTFM with high-resolution epicardial ultrasonography offers a high diagnostic yield.
- Data on fluorescence imaging for coronary and graft vasculature visualization is currently limited.
Conclusions:
- Intraoperative graft assessment is essential for ensuring the long-term patency of bypass grafts.
- Combined TTFM and ultrasonography represent a valuable approach for real-time graft evaluation.
- Further research is needed to explore the utility of fluorescence imaging in this context.
Abstract:
Early graft patency is a major determinant of morbidity and mortality following coronary artery bypass surgery. Long-term graft failure is caused by intimal hyperplasia and atherosclerosis, while early failure, especially in the first year, has been attributed, in part, to surgical error. The need for intraoperative graft evaluation is paramount to determine need for revision and ensure future functioning grafts. Transit time flowmetry (TTFM) is the most commonly used intraoperative modality, however, only about 20% of cardiac surgeons in North America use TTFM. When combined with high resolution epicardial ultrasonography, TTFM provides high diagnostic yield. Fluorescence imaging can provide excellent visualization of the coronary and graft vasculature; however, data on this subject is limited. We herein examine the literature and discuss the available techniques for graft assessment along with their limitations.
