A Flowmeter Technique to Exclude Internal Mammary Artery Anastomosis Error in an Arrested Heart

Hashim, Shahrul Amry; Amin, Mohd Afiq; Nair, Ashvin Krishna; Mokhtar, Raja Amin Raja; Krishnasamy, Sivakumar; Cheng, Kenny

doi:10.1016/j.hlc.2017.11.011

Cited by 9 publications

(5 citation statements)

References 7 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Fabricius et al (15) reported that 23 out of 2,052 (1.1%) patients who underwent CABG had severely compromised hemodynamics due to postoperative MI and 5 out of 23 (21.7%) had incorrect anastomoses. Hashim et al (16) reported that graft flow abnormalities when the heart is arrested at diastole are purely due to technical problems, such as anastomosis errors; thus, checking the PI and graft flow of the internal mammary artery upon completion of the anastomosis and before tying is recommended. Anastomoses reconstructions are recommended if TTFM are unsatisfactory.…”

Section: Discussionmentioning

confidence: 99%

Transit time flow measurement and outcome in coronary artery bypass grafting for surgeon and trainee

Tan¹,

Azmi²,

Zulkifli³

et al. 2022

J Thorac Dis

Self Cite

View full text Add to dashboard Cite

Background: Trainees need to operate under appropriate supervision to become competent. Transit time flow measurement (TTFM) is useful in detecting intraoperative graft failures during coronary artery bypass grafting (CABG). This study aims to compare the intra-and postoperative outcomes, including TTFM, of isolated CABG performed by a single consultant versus trainees and to determine the relationship between the pulsatility index (PI) and postoperative outcomes. Methods: This retrospective study included 155 isolated CABG cases. Intraoperative outcomes included duration of cardiopulmonary bypass (CPB) and aortic cross-clamp and TTFM for arterial and venous grafts.Postoperative outcomes included common postoperative complications and mortality. The odds ratios of postoperative complications and mortality for arterial and venous grafts with PI ≤3 relative to grafts with PI >3 were determined with multiple logistic regression. Results: The duration of CPB and aortic cross-clamp was significantly shorter in the consultant's group.TTFM for both arterial and venous grafts were similar and no significant differences in postoperative complications and mortality were detected between the two groups. Patients with arterial grafts with PI ≤3 were less likely to require an intra-aortic balloon pump (IABP) or be ventilated for a prolonged period. No significant differences in postoperative outcomes and mortality were detected between venous grafts with PI ≤3 and PI >3. Conclusions: Trainees can achieve good results in isolated CABG with appropriate case selection. Patients with arterial grafts with PI ≤3 have better postoperative outcomes.

show abstract

Section: Discussionmentioning

confidence: 99%

Transit time flow measurement and outcome in coronary artery bypass grafting for surgeon and trainee

Tan¹,

Azmi²,

Zulkifli³

et al. 2022

J Thorac Dis

Self Cite

View full text Add to dashboard Cite

show abstract

“…The left internal mammary artery (LIMA) has become the most preferred conduit for revascularization of left anterior descending (LAD) coronary artery nowadays [4-8]. Clinically, the quantity and quality of the graft flow are directly evaluated by an intraoperative transit-time flow measurement (TTFM) that yields the mean graft flow (MGF), pulsatile index (PI), and diastolic flow fraction.…”

Section: Introductionmentioning

confidence: 99%

The Role of Color Doppler Ultrasonography in the Perioperative Period of Coronary Artery Bypass Grafting: Comparison with Transit-Time Flow Measurement

et al. 2021

View full text Add to dashboard Cite

Introduction: The value of color Doppler ultrasonography (CDUS) with the supraclavicular approach for preoperative evaluation of the native left internal mammary artery (LIMA) as well as for the postoperative detection of LIMA graft patency was recently suggested. However, the parameters such as the flow volume and pulsatile index (PI) have not been studied in detail. Objectives: The objectives of this study were to analyze the LIMA data in the perioperative period and explore the relationships between the intraoperative graft flow with transit-time flow measurement (TTFM) and the postoperatively measured parameters with CDUS. Methods: Fifty-eight patients with significant stenosis (≥70%) or occlusions in left anterior descending artery (LAD) who were referred for isolated coronary artery bypass grafting (CABG) were enrolled in this study and examined by CDUS prior to CABG from April to July 2016. The perioperative measurements of proximal LIMA by CDUS were compared. In addition, the correlation between the intraoperative graft flow, such as the mean graft flow (MGF) and PI, and the immediate postoperative measurements of CDUS in LIMA bypassed grafts was statistically analyzed. Results: Six patients were excluded due to screening failure, or insufficient visualization of CDUS images for analysis. Fifty-two patients with in situ LIMA-LAD graft, with or without additional arterial grafts or saphenous vein grafts, were included in the final analysis. The postoperative diameters of proximal LIMA were not significantly different from preoperative diameters (2.21 ± 0.18 vs. 2.27 ± 0.22 mm, p = 0.070). The flow volume on the early postoperative CDUS significantly increased (39.77 ± 21.59 vs. 25.96 ± 13.17 mL/min, p < 0.001) and the PI significantly decreased (1.43 ± 0.46 vs. 4.20 ± 1.49, p < 0.001) versus those of preoperative measurements. The MGF had a moderate correlation with the flow volume on the early postoperative CDUS (r = 0.414, p = 0.002), and the PI by TTFM had a weak correlation with that by CDUS (r = 0.353, p = 0.010) as well. Conclusions: The MGF and PI by TTFM in CABG were associated with in situ LIMA graft parameters measured by CDUS studies. CDUS is a useful functional noninvasive tool for the preoperative screening and postoperative follow-up of patients with in situ LIMA bypass.

show abstract

“…5 However, epicardial ultrasound is not widely available because of the cost, and it can be technically challenging to obtain a good image, especially on a beating heart. 6 Currently, TTFM is the most common technique for assessing blood flow through grafts. 7 The parameters for acceptable bypass graft function are mean graft flow (MGF) > 15 mL·min −1 , pulsatility index (PI) < 5, and diastolic filling of 50%–60% for the left-sided vessels and 45%–55% for the right-sided vessels.…”

Section: Introductionmentioning

confidence: 99%

“…There are no universally accepted threshold criteria to define the proper time for graft revision, and there are scarce data on TTFM parameters on an arrested (crossclamped) heart. 6 In this study, we evaluated the advantage of intraoperative 3-time TTFM of bypass grafts. Each graft had flow measurements on the arrested heart after performing all distal anastomoses, on the beating heart immediately after weaning from cardiopulmonary bypass (CPB), and after protamine administration before wound closure.…”

Section: Introductionmentioning

confidence: 99%

“…8 Very little is known about TTFM graft parameters measured on an arrested (crossclamped) heart. [4][5][6]9 During this measurement, the blood flow is completely laminar and the very low PI is probably reflective of a bypass machine artifact. This value varies from one bypass machine (roller pump) to another, which produce a degree of maximum and minimum blood flow from which the MGF is calculated.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Enhancement of flow measurement for graft verification

Vechersky

Затолокин

Kozlov

et al. 2019

Asian Cardiovasc Thorac Ann

View full text Add to dashboard Cite

Background We aimed to evaluate multiple transit-time flow measurements during coronary artery bypass grafting. Methods Transit-time flow measurements were performed first on the arrested heart both with and without a proximal snare on the target coronary artery, second, after weaning from cardiopulmonary bypass, and third, before chest closure. Results Among the 214 grafts considered, 9 (4.2%) were patent and 6 (2.8%) were failing. In the failed grafts, an abnormal transit-time flow was found during the first measurement, in 5 (2.3%) cases with a proximal snare and in one (0.47%) without a snare. In these cases, technical errors with the distal anastomoses were found and immediately corrected. A problem with the proximal anastomosis was found in one graft during the second measurement and corrected right away. Bending due to excessive length was found in 2 (0.93%) grafts during the third measurement, and graft repositioning was performed. The first transit-time flow measurement showed that mean graft flow was significantly decreased with a proximal snare compared to without a proximal snare, throughout the entire coronary territory. Pulsatility index during the first transit-time flow measurement was higher with a proximal snare than without one. Conclusions The 3-time transit-time flow measurement strategy makes it possible to verify and immediately correct technical problems with coronary bypass grafts.

show abstract

A Flowmeter Technique to Exclude Internal Mammary Artery Anastomosis Error in an Arrested Heart

Cited by 9 publications

References 7 publications

Transit time flow measurement and outcome in coronary artery bypass grafting for surgeon and trainee

Transit time flow measurement and outcome in coronary artery bypass grafting for surgeon and trainee

The Role of Color Doppler Ultrasonography in the Perioperative Period of Coronary Artery Bypass Grafting: Comparison with Transit-Time Flow Measurement

Enhancement of flow measurement for graft verification

Contact Info

Product

Resources

About