Graft revision after transit time flow measurement in off-pump coronary artery bypass grafting

Giuseppe D'Ancona, Hratch L. Karamanoukian, Marco Ricci, Susan Schmid, Jacob Bergsland, Tomas A. Salerno

Research output: Contribution to journalArticle

154 Scopus citations

Abstract

Objective: To determine whether coronary graft patency can be predicted by transit time flow measurement (TTFM). Methods: From May 1 1997 to December 31 1998, TTFM was prospectively evaluated in 409 patients undergoing coronary artery bypass grafting (CABG) without cardiopulmonary bypass (CPB). All grafts (1145) were tested with TTFM. Results: Thirty-seven out of 1145 grafts (3.2%) were revised in 33 patients (7.6%). In six cases (18.1%) use of CPB was necessary during revision due to hemodynamic instability. The remaining patients underwent revision off-pump. Thirty-four grafts (91.9%) were revised for both low flow and abnormal flow curve patterns. Findings at revision included: thrombosis of the anastomosis (n=6), stenosis at the toe or heel of the anastomosis (n=8), coronary flap or dissection (n=5), dissection of the internal mammary artery (n=5), graft kinking (n=4), flap at proximal anastomosis (n=1), coronary stenosis distal to the graft (n=3), and no findings (n=2). After revision all flow values and flow patterns improved. Although three additional grafts (8.1%) were revised for low flow (<7 ml/min) despite normal flow patterns, there were no findings at revision and flow values and curves remained unchanged after revision. Postoperatively, one patient developed a stroke (3%), one had an acute myocardial infarction (MI) (3%), one had a sternal wound infection (3%), and one required prolonged ventilatory support (3%). Conclusion: Evaluation of TTFM is valuable in determining the status of a coronary graft after CABG. Correct interpretation of flow patterns allows for correction of abnormalities prior to chest closure. Copyright (C) 2000 Elsevier Science B.V.

Original languageEnglish (US)
Pages (from-to)287-293
Number of pages7
JournalEuropean Journal of Cardio-Thoracic Surgery
Volume17
Issue number3
DOIs
StatePublished - Mar 1 2000
Externally publishedYes

Keywords

  • Graft
  • Off-coronary pulmonary bypass
  • Revision
  • Transit time flow measurement

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery

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