Publications

Abstract: Early and late graft occlusion remains a significant complication of coronary artery bypass grafting. Transit time flowmetry is the most commonly used imaging technique to assess graft patency intraoperatively. Although the value of transit time flowmetry for intraoperative quality control of coronary anastomosis is well established, its standard variables for predicting eventual graft failure remain controversial. This review readdresses the issue of intraoperative transit time flowmetry, with a particular emphasis on defining cutoff values for standard variables and correlating them with the ability to predict midterm and long-term graft patency for arterial and venous conduits. Further research is warranted to support clinically useful recommendations on the intraoperative application and interpretation of transit time flowmetry.

Objectives: Little is known regarding the transit-time flow measurement (TTFM) variables in grafts anastomosed to chronically totally occluded vessels (CTOs). The investigators aimed to establish the TTFM cut-off values for detecting graft failure in bypass grafts anastomosed to chronically totally occluded arteries and clarify the relationship between early graft failure and the grade of collateral circulation/regional wall motion of the CTO territory.Methods: Among 491 patients who underwent isolated coronary artery bypass grafting (CABG) from 2009 to 2015, 196 cases with CTOs underwent postoperative coronary angiography within 1 month after CABG. Two hundred and forty-one CTOs in all patients were examined.
Thirty-two CTOs (13%) were not bypassed and 214 conduits were anastomosed to CTOs and underwent intraoperative TTFM. Arterial conduits and saphenous vein grafts (SVGs) were used in 102 and 112 cases, respectively. Among the arterial conduit procedures that were performed, 78 involved the left internal thoracic artery (LITA), 10 involved the right internal thoracic artery (RITA) and 14 involved the right gastroepiploic artery (rGEA). Any graft showing Fitzgibbon type B or O lesions on angiography was considered to be a failing graft.

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Objective: Sudden ventricular fibrillation (VF) and myocardial infarction (MI) are life-threatening complications after coronary artery bypass grafting (CABG). We prospectively analysed the impact of intraoperative bypass flow measurement with the transit time flow Doppler method (TTFD) on the incidence and outcome of postoperative VF and MI.Methods:In 1995 a standardized algorithm for the treatment of postoperative VF was introduced in our institution. The rate of postoperative VF was therefore exactly registered. In 1998 the TTFD method was implemented as a standard in all CABG cases. Whenever insufficient bypass graft flow was detected, anastomoses were redone and technical problems affecting the grafts were excluded. The incidence of postoperative VF and CK/CK-MB fraction was observed prospectively and the new data was compared to the data from 1995 to 1998.

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Objective: The purpose of this study is to evaluate the effect of detection of graft dysfunction by intraoperative transit time flow measurement (TTFM) on the surgical results of on-pump coronary artery bypass grafting. Methods: Two hundred patients undergoing on-pump isolate coronary artery bypass grafting via median sternotomy performed by the same surgical team were included into the study. TTFM was routinely performed for assessment of graft patency during operation after a transit time flow meter became available in our center in February 2006. The last 100 consecutive patients before this date formed the control group (Group A), and the first 100 consecutive patients after this date formed the study group (Group B). Interpretation of the values obtained using the TTFM in Group B patients has allowed us to reach a decision whether or not to revise a graft. Preoperative and postoperative variables of the two groups were compared.

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Transit-time flowmetry enables immediate intraoperative assessment of blood flow parameters in coronary artery bypass grafts (CABG).
The present study assesses the predictive value of measured graft flows on early and medium-term outcomes. All cardiac surgery patients with measured graft flows were included. The last intraoperative flow measurements recorded using the Medtronic Butterfly Flowmetry system were used for analysis. Patients were separated into two groups: patients with normal flow in all grafts or patients with abnormal flow ≥ 1 graft. Any pulsatility index (pulsatility index=min-max flow/mean flow) ≤ 5 was determined to be normal flow. The study population included 985 patients. Read more...