1
|
Sigaev IY, Keren MA, Slivneva IV, Shonia ZD, Marapov DI. The Algorithm for Using Transit-time Flow Measurement and High-resolution Epicardial Ultrasound for Intraoperative Grafts Assessment during Coronary Artery Bypass Surgery. KARDIOLOGIIA 2022; 62:3-10. [PMID: 36066981 DOI: 10.18087/cardio.2022.8.n1823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 10/29/2021] [Indexed: 06/15/2023]
Abstract
Aim To develop an algorithm for using ultrasonic flowmetry (USF) and epicardial ultrasonic scanning (EpiUSS) for intraoperative assessment of anatomic and functional viability of conduits.Material and methods For viability assessment of 460 coronary grafts in 150 patients who were operated at the Bakulev National Medical Research Center for Cardiovascular Surgery (2018-2021 г.), markers of graft failure were analyzed using the USF and EpiUSS data confirmed by results of graft angiography. According to RОС analysis, the Qmean and PI values indicative of the graft failure were determined. A CHAID decision tree was developed for assessing the prognostic significance of the analyzed parameters. Based on this prognostic model, an algorithm was developed for intraoperative diagnosis of anatomic and functional graft viability during coronary bypass surgery.Results The Qmean ≤20.5 ml/min values were associated with an increased relative risk (RR) of detecting graft failure (RR, 8.2; 95 % confidence interval, CI, 4.4-15.2). The developed model shows a high accuracy of predicting the graft failure (AUC = 0.906±0.03). The RR of graft failure at PI ≥2.65 was 3.3 (95 % CI, 2.17-5.08). The prognostic model for PI (AUC = 0.745±0.042) was sufficiently accurate with respect of possible graft failure. Nodes of high and low risk for graft failure were determined in the developed decision tree. The obtained model was characterized by high sensitivity and specificity (100 and 84.3 %, respectively).Conclusion The combined use of USF and EpiUSS allows a highly accurate assessment of both morphological and functional characteristics of graft flow. The developed algorithm for the intraoperative diagnosis of anatomic and functional graft viability can be recommended for clinical use.
Collapse
Affiliation(s)
- I Yu Sigaev
- Bakulev National Medical Research Center for Cardiovascular Surgery, Moscow
| | - M A Keren
- Bakulev National Medical Research Center for Cardiovascular Surgery, Moscow
| | - I V Slivneva
- Bakulev National Medical Research Center for Cardiovascular Surgery, Moscow
| | - Z D Shonia
- Bakulev National Medical Research Center for Cardiovascular Surgery, Moscow
| | - D I Marapov
- Kazan State Medical Academy, Branch of the Russian Medical Academy of Continuous Professional Education, Kazan
| |
Collapse
|
2
|
Yang B, Nisivaco S, Torregrossa G, Balkhy HH. Transit Time Flow Measurement in Robotic Totally Endoscopic Coronary Artery Bypass: What Do the Numbers Mean? INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2022; 17:136-141. [DOI: 10.1177/15569845221091515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective Transit time flow measurement (TTFM) is valuable for assessing intraoperative graft patency in coronary artery bypass surgery (CAB). The significance of competitive native coronary flow on patency, as predicted by percentage of backflow (%BF) on TTFM, is unknown. This study aims to evaluate intraoperative TTFM parameters, and specifically %BF, in predicting graft patency in robotic totally endoscopic CAB (TECAB). Methods We reviewed TTFM parameters in 311 patients undergoing robotic off-pump TECAB at our institution between February 2016 and January 2020. Patients with sequential or Y grafts were excluded, leaving 277 patients with a total of 387 isolated end-to-side grafts (248 left internal mammary artery [LIMA], 149 right IMA [RIMA]). Mean graft flow, diastolic flow, pulsatility index, and %BF were measured intraoperatively. Early postoperative angiograms were obtained in 83 patients undergoing percutaneous coronary intervention for hybrid revascularization, with a total of 125 grafts. Angiograms were independently analyzed and separated into 2 groups based on IMA graft patency, which were patent (FitzGibbon A/B) and nonpatent (FitzGibbon O) groups. Results Early angiographic patency at a median of 31.0 days after surgery showed 123 (97.1%) patent grafts and 3 (2.9%) occluded grafts in both LIMA and RIMA grafts to both left anterior descending (LAD) and non-LAD targets. Mean graft flow was 77.4 ± 41.6 mL/min. There was no difference in mean flow, pulsatility index, or %BF between the patent and occluded grafts. Conclusions Excellent intraoperative flow parameters and early angiographic patency can be obtained via robotic, off-pump TECAB. Our data did not demonstrate an association between intraoperative TTFM evidence of competitive native coronary flow and early angiographic graft outcomes.
Collapse
Affiliation(s)
- Benjamin Yang
- Robotic and Minimally Invasive Cardiac Surgery, University of Chicago, IL, USA
| | - Sarah Nisivaco
- Robotic and Minimally Invasive Cardiac Surgery, University of Chicago, IL, USA
| | | | - Husam H. Balkhy
- Robotic and Minimally Invasive Cardiac Surgery, University of Chicago, IL, USA
| |
Collapse
|
3
|
Yamamoto M, Ninomiya H, Handa T, Kidawawa K, Inoue K, Sato T, Hanazaki K, Orihashi K. The impact of the quantitative assessment procedure for coronary artery bypass graft evaluations using high-resolution near-infrared fluorescence angiography. Surg Today 2021; 52:485-493. [PMID: 34415437 DOI: 10.1007/s00595-021-02357-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 06/29/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE Near-infrared angiography (NIR) is used for on-site graft assessment during coronary artery bypass grafting. This study evaluated the results of a quantitative NIR assessment using a new high-resolution NIR device (h-NIR) for graft assessment. METHODS Forty-three patients were enrolled in our study. Internal thoracic artery (ITA) grafts anastomosed to the left anterior descending artery and examined intraoperatively using h-NIR were included. The ITA grafts were divided into 2 groups for a comparative analysis: patent grafts (P group; n = 37) and failed grafts (F group; n = 6). The graft flow was evaluated by a "quantitative NIR assessment", and the fluorescence luminance intensity (FLI) was measured. Direct observation of the graft and anastomosis with h-NIR was also performed. RESULTS The FLI was higher in the P group than in the F group. The receiver operating characteristic analysis revealed the following cut-off values for FLIs depending on imaging duration: 21.1% at 1 s, 35.5% at 2 s, 58.4% at 3 s, and 83.3% at 4 s. The sensitivity and specificity for detecting graft failure were 83.3% and 69.8-80.6%, respectively. Furthermore, h-NIR was also able to visualize arterial dissection in ITA grafts. CONCLUSIONS A quantitative NIR assessment with an h-NIR device can improve the detectability of anastomotic stenosis, and h-NIR successfully detected arterial dissection of grafts.
Collapse
Affiliation(s)
- Masaki Yamamoto
- Department of Surgery, Kidawara Hospital, Nakamura Ichijoh-dohri 3-3-25, Shimanto City, Kochi, 787-0025, Japan. .,Department of Surgery 2, Kochi Medical School, Kochi University, Nankoku City, Kochi, 783-8505, Japan. .,Center for Photodynamic Medicine, Kochi Medical School, Kochi University, Nankoku City, Kochi, 783-8505, Japan.
| | - Hitoshi Ninomiya
- Department of Civil and Environmental Engineering, Toyo University, Kawagoe City, Saitama, 350-8585, Japan
| | - Takemi Handa
- Department of Surgery 2, Kochi Medical School, Kochi University, Nankoku City, Kochi, 783-8505, Japan
| | - Koichi Kidawawa
- Department of Surgery, Kidawara Hospital, Nakamura Ichijoh-dohri 3-3-25, Shimanto City, Kochi, 787-0025, Japan
| | - Keiji Inoue
- Center for Photodynamic Medicine, Kochi Medical School, Kochi University, Nankoku City, Kochi, 783-8505, Japan.,Department of Urology, Kochi Medical School, Kochi University, Nankoku City, Kochi, 783-8505, Japan
| | - Takayuki Sato
- Center for Photodynamic Medicine, Kochi Medical School, Kochi University, Nankoku City, Kochi, 783-8505, Japan.,Department of Cardiovascular Control, Kochi Medical School,Kochi University, Nankoku City, Kochi, 783-8505, Japan
| | - Kazuhiro Hanazaki
- Center for Photodynamic Medicine, Kochi Medical School, Kochi University, Nankoku City, Kochi, 783-8505, Japan.,Department of Surgery 1, Kochi Medical School, Kochi University, Nankoku City, Kochi, 783-8505, Japan
| | - Kazumasa Orihashi
- Department of Surgery 2, Kochi Medical School, Kochi University, Nankoku City, Kochi, 783-8505, Japan.,Center for Photodynamic Medicine, Kochi Medical School, Kochi University, Nankoku City, Kochi, 783-8505, Japan
| |
Collapse
|
4
|
Thuijs DJFM, Bekker MWA, Taggart DP, Kappetein AP, Kieser TM, Wendt D, Di Giammarco G, Trachiotis GD, Puskas JD, Head SJ. Improving coronary artery bypass grafting: a systematic review and meta-analysis on the impact of adopting transit-time flow measurement. Eur J Cardiothorac Surg 2020; 56:654-663. [PMID: 30907418 PMCID: PMC6751409 DOI: 10.1093/ejcts/ezz075] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Revised: 01/18/2019] [Accepted: 02/11/2019] [Indexed: 12/11/2022] Open
Abstract
![]()
Despite there being numerous studies of intraoperative graft flow assessment by transit-time flow measurement (TTFM) on outcomes after coronary artery bypass grafting (CABG), the adoption of contemporary TTFM is low. Therefore, on 31 January 2018, a systematic literature search was performed to identify articles that reported (i) the amount of grafts classified as abnormal or which were revised or (ii) an association between TTFM and outcomes during follow-up. Random-effects models were used to create pooled estimates with 95% confidence intervals (CI) of (i) the rate of graft revision per patient, (ii) the rate of graft revision per graft and (iii) the rate of graft revision among grafts deemed abnormal based on TTFM parameters. The search yielded 242 articles, and 66 original articles were included in the systematic review. Of those articles, 35 studies reported on abnormal grafts or graft revisions (8943 patients, 15 673 grafts) and were included in the meta-analysis. In 4.3% of patients (95% CI 3.3–5.7%, I2 = 73.9) a revision was required and 2.0% of grafts (95% CI 1.5–2.5%; I2 = 66.0) were revised. The pooled rate of graft revisions among abnormal grafts was 25.1% (95% CI 15.5–37.9%; I2 = 80.2). Studies reported sensitivity ranging from 0.250 to 0.457 and the specificity from 0.939 to 0.984. Reported negative predictive values ranged from 0.719 to 0.980 and reported positive predictive values ranged from 0.100 to 0.840. This systematic review and meta-analysis showed that TTFM could improve CABG procedures. However, due to heterogeneous data, drawing uniform conclusions appeared challenging. Future studies should focus on determining the optimal use of TTFM and assessing its diagnostic accuracy.
Collapse
Affiliation(s)
- Daniel J F M Thuijs
- Department of Cardiothoracic Surgery, Erasmus MC, University Medical Centre, Rotterdam, Netherlands
| | - Margreet W A Bekker
- Department of Cardiothoracic Surgery, Erasmus MC, University Medical Centre, Rotterdam, Netherlands
| | - David P Taggart
- Department of Cardiovascular Surgery, University of Oxford, John Radcliffe Hospital, Oxford, UK
| | - A Pieter Kappetein
- Department of Cardiothoracic Surgery, Erasmus MC, University Medical Centre, Rotterdam, Netherlands
| | - Teresa M Kieser
- Division of Cardiac Surgery, Department of Cardiac Sciences, Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Canada
| | - Daniel Wendt
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Centre, University of Duisburg-Essen, Duisburg, Germany
| | - Gabriele Di Giammarco
- Department of Cardiac Surgery, Università degli Studi "G. D'Annunzio" Chieti-Pescara, Chieti, Italy
| | - Gregory D Trachiotis
- Department of Cardiothoracic Surgery, Veterans Affairs Medical Centre, Washington, DC, USA
| | - John D Puskas
- Department of Cardiovascular Surgery, Mount Sinai Saint Luke's, New York, NY, USA
| | - Stuart J Head
- Department of Cardiothoracic Surgery, Erasmus MC, University Medical Centre, Rotterdam, Netherlands
| |
Collapse
|
5
|
Krasopoulos G, D'Alessio A, Verdichizzo D, Muretti M, Turton MJ, Gerry S, Trivella M, Keiralla A, Lucking A, Langrish JP. Beyond patency: Functional assessment of adequacy using internal mammary artery grafting to the left anterior descending artery. J Card Surg 2019; 35:304-312. [PMID: 31765036 DOI: 10.1111/jocs.14366] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Arterial graft physiology influences the long-term outcome of coronary artery bypass grafting (CABG). We studied factors that can affect the overall resistance to flow using internal mammary artery grafting to the left anterior descending artery. METHODS This was a prospective, nonrandomized observational study of 100 consecutive patients who underwent elective on-pump isolated or combined valve surgery and CABG. Coronary stenoses were assessed using conventional and quantitative coronary angiography assessment. The flow and pulsatility index (PI) of the grafts were assessed by transit-time flowmetry during cardioplegic arrest and at the end of the operation. Fractional polynomials were used to explore linearity, followed by multivariable regression analysis. RESULTS Univariate analysis demonstrated higher flows at the end of the operation in patients who had higher flows with the cross-clamp on (P < .001), in males (P = .004), in patients with a low PI at the end of the operation (P = .04), and in patients with a larger size of the recipient artery (P = .005). Multivariable regression analysis showed that the graft flow at the end of the operation was significantly associated with the mean flow with the cross-clamp on (P < .001), sex (P = .003), and PI at the end of the operation (P = .003). Concomitant valve surgery did not influence flows. Male patients had 18 mL/min higher flow. CONCLUSIONS The graft flow at the end of the operation can be determined by the flow with the cross-clamp on, the PI with the cross-clamp off and coronary artery. We reported differences in the graft flows between sexes, and for first the time, we introduced the concepts of "adequate flow" and "resistance-to-forward-flow" for patent coronary grafts.
Collapse
Affiliation(s)
- George Krasopoulos
- Department of Cardiothoracic Surgery, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom.,Department of Cardiothoracic Surgery, University of Oxford, Oxford, United Kingdom
| | - Andrea D'Alessio
- Department of Cardiothoracic Surgery, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Danilo Verdichizzo
- Department of Cardiothoracic Surgery, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Mirko Muretti
- Department of Cardiothoracic Surgery, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Michael J Turton
- Department of Cardiothoracic Surgery, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Stephen Gerry
- Centre for Statistics in Medicine, Botnar Research Centre, University of Oxford, Oxford, United Kingdom
| | - Marialena Trivella
- Centre for Statistics in Medicine, Botnar Research Centre, University of Oxford, Oxford, United Kingdom
| | - Amar Keiralla
- Department of Cardiac Anaesthesia, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Andrew Lucking
- Department of Cardiology, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Jeremy P Langrish
- Department of Cardiology, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| |
Collapse
|
6
|
Yamamoto M, Ninomiya H, Tashiro M, Sato T, Handa T, Inoue K, Orihashi K, Hanazaki K. Evaluation of graft anastomosis using time-intensity curves and quantitative near-infrared fluorescence angiography during peripheral arterial bypass grafting. J Artif Organs 2018; 22:160-168. [PMID: 30467613 DOI: 10.1007/s10047-018-1083-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Accepted: 11/11/2018] [Indexed: 01/29/2023]
Abstract
Near-infrared fluorescence angiography (NIR) visualizes blood perfusion using the fluorescence property of indocyanine green (ICG). This study aimed to retrospectively determine the usefulness of a quantitative analysis using NIR to predict the patency of peripheral arterial bypass grafts by measuring their fluorescence luminance intensities (FLIs).Thirteen grafts in 11 patients who underwent peripheral arterial bypass grafting were divided into a patent graft group (n = 7) and a failed graft group (n = 6). The changes in the FLIs of ICG opacification through the graft and distal host artery were retrospectively analyzed using stored NIR data. The time-intensity curves (TICs) of ICG opacification through the graft (Qgraft) and distal host artery (Qdistal) were measured. Two parameters, Δ(Qgraft - Qdistal) and integral(Qgraft - Qdistal), were also analyzed.Although not significant, decreases in Qgraft were observed in the failed graft groups. The Qdistal of the failed graft group was significantly attenuated as compared with that of the patent graft group. Δ(Qgraft - Qdistal) increased only in the failed graft group, which indicates widening of the gap in FLI. Integral(Qgraft - Qdistal) was higher in the failed graft group, as it reflects the accumulation of ICG opacification.The TICs were influenced by anastomotic stenosis in the distal site of the host arteries. Our results indicate that the comparison of Δ(Qgraft - Qdistal) and integral (Qgraft - Qdistal) quantitatively analyzed using NIR can potentially predict anastomotic stenosis.
Collapse
Affiliation(s)
- Masaki Yamamoto
- Department of Operating Management, Kochi Medical School, Kochi University, Kohasu Oko-cho 185-1, Nankoku, Kochi, 783-8505, Japan. .,Department of Surgery 2, Kochi Medical School, Kochi University, Kohasu Oko-cho 185-1, Nankoku, Kochi, 783-8505, Japan. .,Center for Photodynamic Medicine, Kochi Medical School, Kochi University, Kohasu Oko-cho 185-1, Nankoku, Kochi, 783-8505, Japan.
| | - Hitoshi Ninomiya
- Integrated Centre for Advanced Medical Technologies, Kochi Medical School, Kochi University, Kohasu Oko-cho 185-1, Nankoku, Kochi, 783-8505, Japan.,Faculty of Science and Engineering, Department of Civil and Environmental Engineering, Toyo University, 2100, Kujirai, Kawagoe, Saitama, 350-8585, Japan
| | - Miwa Tashiro
- Department of Surgery 2, Kochi Medical School, Kochi University, Kohasu Oko-cho 185-1, Nankoku, Kochi, 783-8505, Japan
| | - Takayuki Sato
- Center for Photodynamic Medicine, Kochi Medical School, Kochi University, Kohasu Oko-cho 185-1, Nankoku, Kochi, 783-8505, Japan.,Department of Cardiovascular Control, Kochi Medical School, Kochi University, Kohasu Oko-cho 185-1, Nankoku, Kochi, 783-8505, Japan
| | - Takemi Handa
- Department of Surgery 2, Kochi Medical School, Kochi University, Kohasu Oko-cho 185-1, Nankoku, Kochi, 783-8505, Japan
| | - Keiji Inoue
- Center for Photodynamic Medicine, Kochi Medical School, Kochi University, Kohasu Oko-cho 185-1, Nankoku, Kochi, 783-8505, Japan.,Department of Urology, Kochi Medical School, Kochi University, Kohasu Oko-cho 185-1, Nankoku, Kochi, 783-8505, Japan
| | - Kazumasa Orihashi
- Department of Surgery 2, Kochi Medical School, Kochi University, Kohasu Oko-cho 185-1, Nankoku, Kochi, 783-8505, Japan.,Center for Photodynamic Medicine, Kochi Medical School, Kochi University, Kohasu Oko-cho 185-1, Nankoku, Kochi, 783-8505, Japan
| | - Kazuhiro Hanazaki
- Department of Operating Management, Kochi Medical School, Kochi University, Kohasu Oko-cho 185-1, Nankoku, Kochi, 783-8505, Japan.,Center for Photodynamic Medicine, Kochi Medical School, Kochi University, Kohasu Oko-cho 185-1, Nankoku, Kochi, 783-8505, Japan.,Department of Surgery 1, Kochi Medical School, Kochi University, Kohasu Oko-cho 185-1, Nankoku, Kochi, 783-8505, Japan
| |
Collapse
|
7
|
Ji Q, Xia L, Shi Y, Ma R, Shen J, Lai H, Ding W, Wang C. In Situ Skeletonized Right Internal Mammary Artery Bypass Grafting to Left Anterior Descending Artery. Int Heart J 2017; 59:35-42. [PMID: 29279526 DOI: 10.1536/ihj.16-554] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
This study aimed to evaluate the feasibility and the mid-term efficacy of an in situ skeletonized right internal mammary artery (IMA) bypass grafting to a left anterior descending artery (LAD), and to determine risk factors for IMA graft failure in a single-center study.From January 2012 to December 2015, 189 patients (173 males, 50.6 ± 6.0 years old) undergoing first isolated coronary artery bypass grafting surgery with the in situ skeletonized right IMA grafting to the LAD were included in this study. Baseline characteristics, peroperative data, and follow-up outcomes were investigated and analyzed.The length of the in situ skeletonized right IMA grafts was 18.6 ± 1.2 cm (17.0-22.0 cm). Intraoperative graft flow of the in situ skeletonized right IMA grafting to LAD was 42 ± 9 mL/minute (18-72 mL/minute) associated with measured pulsatility index of 0.8-4.3. In-hospital mortality was 0.5%. Postoperative morbidity included acute myocardial infarction (0.5%), stroke (0.5%), and deep sternal wound infections (1.1%). The mid-term survival was 97.2% and the incidence of repeat revascularization was 0.6%. The patency rate of the in situ skeletonized right IMA grafting to the LAD was 97.1% by computed tomography angiography examination during the follow-up period of 23.2 ± 9.7 months. Additionally, logistic regression analysis showed that intraoperative graft flow had an independent influence on the risk of the mid-term right IMA graft failure.The strategy of the in situ skeletonized right IMA grafting to the LAD is feasible and effective. Intraoperative graft flow was an independent risk factor for the mid-term right IMA graft failure.
Collapse
Affiliation(s)
- Qiang Ji
- Department of Cardiovascular Surgery, Zhongshan Hospital Fudan University
| | - LiMin Xia
- Shanghai Institute of Cardiovascular Disease
| | - YunQing Shi
- Department of Cardiovascular Surgery, Zhongshan Hospital Fudan University
| | - RunHua Ma
- Department of Cardiovascular Surgery, Zhongshan Hospital Fudan University
| | - JinQiang Shen
- Department of Cardiovascular Surgery, Zhongshan Hospital Fudan University
| | - Hao Lai
- Department of Cardiovascular Surgery, Zhongshan Hospital Fudan University
| | - WenJun Ding
- Shanghai Institute of Cardiovascular Disease
| | - ChunSheng Wang
- Department of Cardiovascular Surgery, Zhongshan Hospital Fudan University
| |
Collapse
|
8
|
Hiraoka A, Fukushima S, Miyagawa S, Yoshikawa Y, Saito S, Domae K, Sakaguchi T, Toda K, Sawa Y. Quantity and quality of graft flow in coronary artery bypass grafting is associated with cardiac computed tomography study-based anatomical and functional parameters. Eur J Cardiothorac Surg 2017; 52:909-916. [DOI: 10.1093/ejcts/ezx210] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Accepted: 04/07/2017] [Indexed: 01/28/2023] Open
|
9
|
Niclauss L. Techniques and standards in intraoperative graft verification by transit time flow measurement after coronary artery bypass graft surgery: a critical review. Eur J Cardiothorac Surg 2016; 51:26-33. [PMID: 27298393 DOI: 10.1093/ejcts/ezw203] [Citation(s) in RCA: 64] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Revised: 04/29/2016] [Accepted: 05/15/2016] [Indexed: 12/14/2022] Open
Abstract
Transit time flow measurement (TTFM) is a quality control tool for intraoperative graft evaluation in coronary artery bypass graft (CABG) surgery. A critical review of the literature available using TTFM in CABG surgery is the focus of this article. The main objectives will be to detail precise parameters for flow evaluation, to show limitations of TTFM and to prove its predictive impact on postoperative graft failure rate. Publications listed in the PubMed database were reviewed, searching for intraoperative graft verification in coronary surgery by TTFM, with postoperative imaging follow-up (FU) modality and with a special focus on publications released after European guidelines from 2010. Nine included publications revealed an overall graft failure rate of ∼12%. Mean graft flow had a positive predictive value in the largest study, and cut-offs, of at least 20 ml/min for internal mammary artery (IMA) grafts, therein partially confirming guidelines, and 30-40 ml/min for saphenous venous grafts (SVGs) were proposed. An explicit correlation between graft flow, patency rate and severity of coronary stenosis, by indicating the fractional flow reserve, was found for IMA grafts. Increased pulsatility index and increased systolic reverse flow probably predict worse outcome and may help identifying competitive flow. Diastolic filling, rarely indicated, could not be confirmed as the predictive marker. No significant correlation of TTFM and graft failure rate for radial and other arterial grafts could be found, partially due to the small number of these types of grafts analysed. Larger target vessels and lower postoperative CK-MB levels may predict better graft patency rates. Low sensitivity for TTFM to reliably detect graft failure is certainly a major issue, as found in randomized analyses. However, methodical limitations and varying threshold values for TTFM render a general consensus difficult. Influence of quantity (vessel territory distribution) and quality (myocardial scar) of the graft perfusion area, on TTFM and FU outcome, was not included by anyone and should be part of future research. TTFM is probably not the tool of choice to detect progressive late graft failure of SVG. Peroperative TTFM values should be correlated with one type of conduit, differentiating between early and late graft failure (by applying a uniform, appropriated definition), to precise and confirm threshold values.
Collapse
Affiliation(s)
- Lars Niclauss
- Department of Cardiovascular Surgery, University Hospital of Lausanne (CHUV), Lausanne, Switzerland
| |
Collapse
|
10
|
Maximal blood flow acceleration analysis in the early diastolic phase for aortocoronary artery bypass grafts: a new transit-time flow measurement predictor of graft failure following coronary artery bypass grafting. Surg Today 2016; 46:1325-33. [DOI: 10.1007/s00595-016-1325-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Accepted: 01/26/2016] [Indexed: 10/22/2022]
|