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Transit-time flow measurement for detection of early graft failure during myocardial revascularization
B H Walpoth1, A Bosshard, I Genyk
1Department of Thoracic and Cardiovascular Surgery, University Hospital, Berne, Switzerland. beat.walpoth@insel.ch
Insights
Intraoperative graft flow assessment using transit-time flow can identify and correct issues in coronary artery bypass surgery, preventing graft failure and reducing perioperative complications.
Area of Science:
- Cardiovascular Surgery
- Vascular Physiology
- Surgical Technology
Background:
- Low graft flow in arterial and venous grafts correlates with increased perioperative infarction and mortality.
- Accurate assessment of intraoperative graft function is crucial for patient outcomes in coronary artery disease surgery.
Purpose of the Study:
- To evaluate intraoperative graft flow and resistance in patients undergoing coronary artery bypass grafting.
- To determine the utility of transit-time flow measurements for assessing early graft performance.
Main Methods:
- Coronary artery bypass graft flow was measured in 46 patients using transit-time flow.
- Flow measurements were taken at rest and after maximal vasodilation with adenosine infusion.
Main Results:
- Normal internal mammary artery graft flow (>20 mL/min) was observed in 43 patients.
- Three patients with minimal flow had flow normalized after revision of the anastomosis, with significant increases in flow and decreases in resistance and pulsatility index.
- Post-correction coronary flow reserve was 2.5 +/- 1.1.
Conclusions:
- Intraoperative measurement of graft flow and resistance aids in assessing early graft function.
- This assessment can help prevent graft failure and reduce perioperative infarction.
- Transit-time volume flow is a valuable tool for quality control in coronary bypass procedures.
Background:
A low-flow situation in arterial and venous grafts has been associated with high rates of perioperative infarction and mortality. This study was designed to look at intraoperative graft flow and resistance in patients with coronary artery disease.
Methods:
Coronary artery bypass graft flow was measured in 46 patients. Transit-time flow was used for coronary flow measurements at rest as well as after maximal vasodilation with adenosine infusion.
Results:
Forty-three of the 46 patients showed normal internal mammary artery graft flow (>20 mL/min); 3 patients had no or minimal graft flow. Redoing the graft anastomosis in these 3 patients resulted in normalization of graft flow. The mean flow increased significantly after correction from 0.5 +/- 0.7 mL/min to 15.7 +/- 9.6 mL/min (p < 0.02). Conversely, vascular resistance decreased significantly from 138 +/- 10 to 4.8 +/- 1.8 Ohmv (p < 0.0001), as did the pulsatility index (from 146.9 +/- 95.7 to 3.4 +/- 1.8; p < 0.001). After correction, coronary flow reserve was 2.5 +/- 1.1.
Conclusions:
Measurements of intraoperative flow and resistance as well as derived variables allow assessment of early graft function and thus help prevent graft failure and reduce perioperative infarction. Transit-time volume flow might be a simple tool for quality control in coronary bypass procedures.