Publications

The Task Force on Myocardial Revascularization of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS) recommend graft assessment by TTFM and epiaortic HFUS prior to manipulation. Read more…

Objective: Transit-time flow measurement is widely accepted as an intra-operative assessment in coronary artery bypass grafting (CABG).However, the two most commonly applied flowmeters, manufactured by MediStim ASA and Transonic Inc., have different default filter settings of 20 and 10 Hz, respectively. This may cause different flow measurements, which will influence the reported results. The aim was to compare pulsatility index (PI) values recorded by the MediStim and Transonic flowmeters in two different clinical settings: (1) analysis of the flow patterns recorded simultaneously by both flowmeters in the same CABGs; and (2) evaluation of flow patterns under different levels of filter settings in the same grafts.

Methods: Graft flow and PI were measured using the two different flowmeters simultaneously in 19 bypass grafts. Finally, eight grafts were assessed under different digital filter settings at 5, 10, 20, 30, 50 and 100 Hz.

Results: Read more...

Objectives: The detection of embedded coronary arteries is difficult especially in off-pump coronary bypass surgery. From June 2010, we introduced high-frequency epicardial ultrasound (ECUS) to assess and evaluate embedded arteries during off-pump coronary bypass surgery.

Methods: Between June 2010 and June 2011, a total of 89 consecutive patients underwent isolated coronary bypass surgery at our institution. The patients consisted of 72 men and 17 women with a mean age of 67.9 years. We routinely use the VeriQ CTM system (Medistim, Oslo, Norway) to detect the target vessels in the operation. The patients were assigned to one of two groups, depending on whether ECUS was used in the operation (n = 10, ECUS group) or not (n = 79, non-ECUS group). We analyzed the impact of introducing the ECUS in terms of operative outcome.

Results: Read more...

Abstract: Cardiac ischemia after coronary artery bypass grafting is often caused by graft occlusion. Short- and long-term graft patency is related to the quality of the surgical technique during harvesting and anastomosis. Transit time flow measurement is a recognized technique for the quality control of grafts but may not rule out structural abnormalities in the conduits, which can cause graft occlusion. This article reports on two cases of suspected intra-arterial dissection of the left internal mammary artery despite satisfactory flow measurements. Routine ultrasound scanning of arterial conduits is helpful in distinguishing dissection and hematoma in the graft conduits.

Purpose of review: The coronary artery bypass graft (CABG) operation is one of the few remaining operations/interventions on diseased arteries that are not routinely verified during or immediately after the procedure. This review answers the ‘how’, ‘when’ and ‘why’ of intraoperative CABG assessment.

Recent findings: More recent than new literature on this topic, is the increased interest in quality assurance of CABG. This is most likely due to reports in the last 5 years suggesting CABG superiority to percutaneous coronary intervention (PCI) for improved mid-term and long-term outcomes; for example, for patients with diabetes mellitus (Freedom Trial by Farkouh in 2012), and for patients with SYNTAX score  33 (SYNTAX Trial by Mohr in 2013). Possibly CABG is re-emerging from the era-of-better-and-better-stents and is now deemed worthy of improvement. Read more...