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Pulsed Doppler intraoperative flow assessment and midterm coronary graft patency
Y A Louagie1, C E Brockmann, J Jamart
1Unit of Cardiovascular and Thoracic Surgery, University Hospital of Mont-Godinne, Catholic University of Louvain, Yvoir, Belgium.
Insights
Intraoperative hemodynamic measurements, including graft resistance, can predict midterm patency of aortocoronary bypass grafts. Higher resistance indicates a poorer prognosis for graft survival.
Area of Science:
- Cardiovascular Surgery
- Medical Devices
- Hemodynamics
Background:
- Assessing the midterm patency of coronary bypass grafts is crucial for patient outcomes.
- Intraoperative hemodynamic measurements offer a potential method for predicting graft success.
Purpose of the Study:
- To evaluate the predictive value of intraoperative hemodynamic parameters for midterm patency of coronary bypass grafts.
- To identify specific hemodynamic factors influencing graft success.
Main Methods:
- Utilized a pulsed Doppler flowmeter to assess hemodynamic parameters of 214 coronary bypass grafts (89 arterial, 125 venous) in 85 patients.
- Correlated intraoperative measurements with midterm patency determined via angiographic evaluation over a 7-year period.
Main Results:
- Overall graft patency rate was 88.3%.
- Significantly lower mean flow (36 mL/min vs. 60 mL/min) and higher resistance (5.9 PRU vs. 1.8 PRU) were observed in occluded grafts.
- Multivariate analysis identified increased graft resistance, longer interval to angiography, and preoperative cardiogenic shock as independent predictors of reduced patency.
Conclusions:
- Intraoperative hemodynamic status is a significant determinant of midterm aortocoronary bypass graft patency.
- Graft resistance measured during surgery is a key factor in predicting long-term graft success.
Background:
This study was designed to assess the value of hemodynamic measurements taken intraoperatively in predicting midterm patency of coronary bypass grafts.
Methods:
A pulsed Doppler flowmeter was routinely used during operation to determine the hemodynamic parameters of coronary bypass grafts. During a 7-year period, 85 patients underwent angiographic evaluation. As a result, a thorough hemodynamic assessment of 214 grafts (89 arterial and 125 venous) at initial operation was available for analysis.
Results:
The overall patency rate was 88.3%. The mean flow measured intraoperatively in 168 intact grafts was 60+/-3 mL/min (range, 9 to 230 mL/min), and the resistance was 1.8+/-0.1 peripheral resistance units (range, 0.3 to 9.0 peripheral resistance units). The mean flow was 36+/-5 mL/min (range, 2 to 107 mL/min), and the resistance was 5.9+/-2.0 peripheral resistance units (range, 0.6 to 46.0 peripheral resistance units) in 25 grafts found occluded at angiographic evaluation. Multivariate analysis identified three independent variables associated with a reduced patency rate: increased resistance as measured in the graft (p = 0.012), increasing interval of control angiography (p = 0.006), and preoperative cardiogenic shock (p = 0.040).
Conclusions:
The prognosis for midterm patency of aortocoronary bypass grafts depends on the intraoperative hemodynamic status.