Evaluation of gastroepiploic arterial grafts to right coronary artery using transit-time flow measurement

Uehara, Mayuko; Muraki, Satoshi; Takagi, Nobuyuki; Yanase, Yohsuke; Tabuchi, Masaki; Tachibana, Kazutoshi; Miyaki, Yasuko; Ito, Toshiro; Kawaharada, Nobuyoshi; Higami, Tetsuya

doi:10.1093/ejcts/ezu229

Cited by 15 publications

(9 citation statements)

References 21 publications

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“…In CABG surgery, early graft failure is not infrequent, with an occurrence rate of 5% to 20% . With the introduction of TTFM, the cardiac surgeon can now not only document the patency of their anastomoses at the end of the operation but can also better assess the functional capacity of the grafts they perform.…”

Section: Discussionmentioning

confidence: 99%

“…In a recent review of published TTFM studies, Niclauss et al concluded that the mean graft flow positively predicts long‐term patency (minimum threshold of 20 mL/min for IMA grafts and 30‐40 mL/min for vein grafts) . Coronary artery bypass graft failure has been associated with the following: high fractional flow reserve (FFR) (which was also associated with high mean PI, probably due to competitive, antegrade flow from the native coronary artery); TTFM measurements in the early diastolic phase; smoothness of the graft‐flow curve for arterial grafts; and high PI and high systolic reverse flow . Published work from our group has shown that differences of TTFM parameters between left‐ and right‐sided vein grafts were small and unlikely to be of clinical relevance …”

Section: Discussionmentioning

confidence: 99%

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Beyond patency: Functional assessment of adequacy using internal mammary artery grafting to the left anterior descending artery

et al. 2019

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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.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Beyond patency: Functional assessment of adequacy using internal mammary artery grafting to the left anterior descending artery

et al. 2019

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“…Although a statistically significant correlation between TTFM and flow at follow-up has been debated, most studies agree on PI being directly and independently related to increased risk of graft failure or adverse inhospital cardiac events [5,8,14,16,26], albeit with a few exceptions [20,25,31].…”

Section: Cutoff Value For Pimentioning

confidence: 99%

Relationship of Intraoperative Transit Time Flowmetry Findings to Angiographic Graft Patency at Follow-Up

Amin

Pinho-Gomes

Taggart

2016

The Annals of Thoracic Surgery

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“…Contrary to ITAs and SV grafts, Lehnert et al 21 did not find any correlation between MGF and RA graft failure, but general conclusions are limited due to the small number of the studies. Similarly, Uehara et al 25 found no significant differences in MGF values of occluded versus patent RGEA grafts to the RCAs. They suggested that the MGFs of patent RGEA grafts are relatively lower than the value obtained with ITA or SV grafts, because RGEA is a visceral artery and the fourth branch of the aorta.…”

Section: Mgf and Graft Conduitsmentioning

confidence: 89%

Roles of Transit-Time Flow Measurement for Coronary Artery Bypass Surgery

Takami

Takagi

2018

Thorac cardiovasc Surg

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Transit-time flow measurement (TTFM) has been increasingly applied to detect graft failure during coronary artery bypass grafting (CABG), because TTFM is less invasive, more reproducible, and less time consuming. Many authors have attempted to validate TTFM and to gain the clear cutoff values and algorithm in TTFM to predict graft failure. The TTFM technology has also been shown to be a useful tool to investigate CABG graft flow characteristics and coronary circulation physiology. It is important to recognize the practical roles of TTFM in the cardiac operating room by review and summarize the literatures.

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Evaluation of gastroepiploic arterial grafts to right coronary artery using transit-time flow measurement

Abstract: Previously reported cut-off values for intraoperative TTFM parameters could not be adapted for the early patency of GEA grafts to the RCA. However, the smoothness of the graft-flow curve may be a reliable predictor of postoperative graft patency.

Cited by 15 publications

References 21 publications

Beyond patency: Functional assessment of adequacy using internal mammary artery grafting to the left anterior descending artery

Beyond patency: Functional assessment of adequacy using internal mammary artery grafting to the left anterior descending artery

Relationship of Intraoperative Transit Time Flowmetry Findings to Angiographic Graft Patency at Follow-Up

Roles of Transit-Time Flow Measurement for Coronary Artery Bypass Surgery

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