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Effect of transit time flow meter spike waveform on graft patency and its hemodynamic characteristics in coronary
Minghui Wei1, Zhou Zhao2, Mengyao Duan3
1School of Life Sciences, Beijing University of Chinese Medicine, Beijing, China.
Insights
A "spike waveform" during coronary artery bypass grafting (CABG) surgery negatively impacts saphenous vein graft (SVG) patency, especially long-term. This waveform also creates unfavorable hemodynamic conditions in both SVG and left internal mammary artery (LIMA) grafts.
Area of Science:
- Cardiovascular Surgery
- Medical Imaging
- Biomedical Engineering
Background:
- Coronary artery bypass grafting (CABG) relies on transit time flow meters (TTFM) to assess graft patency.
- A specific
Purpose of the Study:
- To investigate the impact of a
Main Methods:
- Collected intraoperative TTFM waveform and postoperative coronary CT angiography (CTA) data from 1154 CABG patients.
- Assessed graft patency in "spike" and "non-spike" waveform groups, with 1-year follow-up CTA for 239 patients.
- Modeled CABG to calculate hemodynamic parameters like relative residence time (RRT) and oscillating shear index (OSI).
Main Results:
- Spike waveforms showed 0% occlusion for LIMA vs. 5.13% for non-spike (immediate).
- SVG occlusion rates were 8.59% for spike vs. 5.79% for non-spike (immediate).
- Medium-long term patency showed significantly higher occlusion rates for SVG spike waveforms (42.47%) compared to non-spike (16.84%).
- Both LIMA and SVG spike waveforms exhibited unfavorable hemodynamic conditions (higher RRT and OSI).
Conclusions:
- Spike waveforms reduce immediate SVG patency and significantly decrease medium-long term SVG patency.
- LIMA graft patency is unaffected by spike waveforms.
- Spike waveforms lead to adverse hemodynamic environments in both LIMA and SVG grafts.
Abstract:
ObjectiveDuring coronary artery bypass grafting(CABG), surgeons commonly use transit time flow meter (TTFM) to determine the graft patency. This study is to explore the effect of a special "spike waveform" in CABG on graft patency and its hemodynamic environment.MethodsWe collected the data of 1154 patients undergoing CABG, including intraoperative TTFM waveform and coronary CTA at 1 week after surgery. 239 patients had 1-year follow-up CTA. We divided the grafts into spike and non-spike waveform groups, and assessed the patency of grafts. Additionally, we constructed an ideal model of CABG, we also calculated and extracted the hemodynamic parameters of the grafts.ResultsFor immediate patency, the occlusion rates of spike and non-spike waveforms of left internal mammary artery(LIMA) were 0 and 5.13%, those of saphenous vein graft(SVG) were 8.59% and 5.79%. As for medium-long term patency, the occlusion rates of spike and non-spike waveforms were 0 and 12.56% for LIMA, and 42.47% and 16.84% for SVG. Regarding hemodynamics, the relative residence time(RRT) and Max Oscillating shear index(MaxOSI) of the LIMA spike waveform were significantly higher than those of the non-spike waveform, and the mean OSI and MaxOSI of the SVG spike waveform were substantially higher than those of the non-spike waveform.ConclusionsSpike waveform slightly reduces the immediate patency of SVG and significantly reduces the medium-long term patency, while no effect on the patency of LIMA is found. In terms of hemodynamics, both LIMA and SVG with spike waveforms exhibit unfavorable hemodynamic conditions within the grafts.
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