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Quantity and quality of graft flow in coronary artery bypass grafting is associated with cardiac computed tomography
Arudo Hiraoka1, Satsuki Fukushima1, Shigeru Miyagawa1
1Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Osaka, Japan.
Insights
Graft flow in coronary artery bypass grafting (CABG) is linked to coronary artery and left ventricle anatomy. Key factors include stenosis, diameter, and calcium score, influencing mean graft flow (MGF) and pulsatile index (PI).
Area of Science:
- Cardiovascular Surgery
- Medical Imaging
- Hemodynamics
Background:
- Coronary artery bypass grafting (CABG) outcomes can be influenced by graft flow dynamics.
- Graft flow is potentially affected by the anatomical and pathological features of the coronary artery and target myocardium.
Purpose of the Study:
- To investigate the relationship between graft flow parameters and cardiac/coronary anatomical characteristics in CABG patients.
- To identify anatomical predictors of successful graft flow in CABG.
Main Methods:
- A study involving 63 patients undergoing isolated CABG.
- Cardiac computed tomography was used to assess coronary artery and left ventricle anatomy.
- Statistical analysis correlated intraoperative graft flow (mean graft flow - MGF, pulsatile index - PI) with anatomical parameters in 104 grafts.
Main Results:
- Mean graft flow (MGF) positively correlated with perfused left ventricle mass volume and coronary artery diameter/stenosis.
- Pulsatile index (PI) negatively correlated with coronary artery diameter/stenosis.
- Abnormal graft flow was associated with smaller distal coronary artery diameter and higher calcium scores.
Conclusions:
- Intraoperative MGF and PI in CABG are significantly associated with anatomical parameters of the target coronary artery and left ventricle.
- Coronary artery stenosis, diameter, calcium score, and left ventricle mass volume are important determinants of graft flow.
Objectives:
Graft flow in coronary artery bypass grafting (CABG) may be determined by the anatomical and pathological characteristics of the coronary artery and target myocardium. Our goal was to explore the relationships between graft flow and the cardiac/coronary parameters in CABG.
Methods:
We enrolled 63 patients who underwent isolated CABG and were examined by cardiac computed tomography. We statistically analysed the correlation between the intraoperative graft flow, such as the mean graft flow (MGF) or the pulsatile index (PI), and the computed tomography scan-based anatomy of the coronary artery tree and the left ventricle in 104 individually bypassed grafts.
Results:
The MGF displayed a significantly positive correlation with the perfused left ventricle mass volume (r = 0.3583, P = 0.0002), and the percentage of stenosis and the diameter of the coronary artery (r = 0.2396, P = 0.0148 and r = 0.2972, P = 0.0022). The PI displayed a negative correlation with the percentage of stenosis and the diameter of the coronary artery (r = -0.2826, P = 0.0038 and r = -0.2796, P = 0.0040). Abnormal graft flow (PI >5.0, and MGF <20 ml/min in arterial graft and MGF <40 ml/min in vein graft) was found in 9 grafts. The internal diameter of the coronary artery at the distal anastomosis site was significantly smaller [1.35 (1.15-1.64) mm vs 1.71 (1.5-2.1) mm, P = 0.0065], and the distal calcium score of the target coronary artery was significantly higher [40 (4-61) vs 0.4 (0-10), P = 0.014] in the abnormal grafts.
Conclusions:
Intraoperatively measured MGF and PI in CABG were associated with cardiac anatomical parameters, such as the percentage of stenosis, internal diameter or calcium score of the target coronary artery or perfused left ventricle mass volume.
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