Graft flow assessment using a transit time flow meter in fractional flow reserve–guided coronary artery bypass surgery

Honda, Kentaro; Okamura, Yoshitaka; Nishimura, Yoshiharu; Uchita, Shunji; Yuzaki, Mitsuru; Kaneko, Masahiro; Yamamoto, Noriaki; Kubo, Takashi; Akasaka, Takashi

doi:10.1016/j.jtcvs.2015.02.050

Cited by 60 publications

(62 citation statements)

References 12 publications

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“…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%

“…Graft failure is generally associated with the severity of the proximal stenosis, which in turn affects competitive flow from native vessels, other bypass grafts or collateral vessels, and the quality of the grafted vessel and tandem myocardium perfused by the grafted vessel . Differences between microvascular health and microvascular disease, as described by Gutterman et al may also play a fundamental role.…”

Section: Introductionmentioning

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: Introductionmentioning

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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“…Interestingly, attenuated disturbed flow with stagnation appeared in the inlet vessel wall of the diffuser model. However, this flow pattern in the inlet vessel is absent in the coronary artery in vivo . The aforementioned velocity and flow profiles are visualized with heatmap colors (Figure e; Video S4, Supporting Information).…”

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confidence: 99%

Development of a Shape‐Memory Tube to Prevent Vascular Stenosis

et al. 2019

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Figure S1 and Video S1, Supporting Information). Vessel-damage-free deployment requires the shape recovery of a graft through circumferential tube expansion by ≈40%-50% to fit the host vessel after insertion (Videos S1-S3, Supporting Information). Hence, a new class of shape memory polymer (SMP) library was synthesized through ring opening polymerization [3] with ε-caprolactone (CL) and glycidyl methacrylate (GMA) monomers (Figure 1a; Figure S2, Supporting Information). Vessel property-matching optimization necessitated a combinatorial design strategy [4] to produce tunable SMP properties through a series of development steps (Figure 1b-g). First, the idea of decreasing the shape recovery temperature, which was represented by melting temperature (T m ), to the body temperature range was validated [5] by the differential scanning calorimetry (DSC) (Figure 1b). T m decreased from the temperature of the base poly(ε-caprolactone) (PCL) to that of our SMPs because crosslinking reduced the crystallinity of PCL. This effect was more dominant compared to the increase in the tightness of the polymer chains owing to Inserting a graft into vessels with different diameters frequently causes severe damage to the host vessels. Poor flow patency is an unresolved issue in grafts, particularly those with diameters less than 6 mm, because of vessel occlusion caused by disturbed blood flow following fast clotting. Herein, successful patency in the deployment of an ≈2 mm diameter graft into a porcine vessel is reported. A new library of property-tunable shape-memory polymers that prevent vessel damage by expanding the graft diameter circumferentially upon implantation is presented. The polymers undergo seven consecutive cycles of strain energy-preserved shape programming. Moreover, the new graft tube, which features a diffuser shape, minimizes disturbed flow formation and prevents thrombosis because its surface is coated with nitric-oxide-releasing peptides. Improved patency in a porcine vessel for 18 d is demonstrated while occlusive vascular remodeling occurs. These insights will help advance vascular graft design. Biomedicine

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“…Finally it's important to mention that fractional flow reserve measurement preoperatively along with real-time graft flow assessment using epigraftic ultrasonography perioperatively is pivotal for assuring long-term patency of the grafts (26,27). Unfortunately, none of these tests are routinely used in everyday practice.…”

Section: Concernsmentioning

confidence: 99%

Off-pump coronary artery bypass grafting in left main stem stenosis: outcomes, concerns and controversies

Athanasopoulos

Athanasiou

2016

J. Thorac. Dis.

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Left main stem (LMS) disease is known to be a poor prognostic factor in terms of morbidity or mortality. Traditionally, it has been treated with constitution of bypass to provide required haemodynamic stability. We searched the literature for evidence on off-pump (OFP) surgery for treating this high-risk group of patients focusing in our review on postoperative outcomes, concerns and controversies. The majority of the studies identified showed favourable or equal outcomes of OFP when compared to conventional approach. All of the studies, apart from two, which showed lower incidence of postoperative deaths, demonstrated equal mortality rates. Stroke rates were found less in three studies. Less blood transfusions, inotropic use and length of study has been also demonstrated. The main concerns of OFP surgery are: haemodynamic instability and less complete revascularization. Main controversies are: same or favourable outcomes despite lower number of grafts with OFP surgery and less stroke rates despite manipulation of aorta with side-clamping. Despite these concerns and controversies OFP surgery has been proven to be feasible and safe as demonstrated by results from numerous studies.

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Graft flow assessment using a transit time flow meter in fractional flow reserve–guided coronary artery bypass surgery

Abstract: As coronary stenosis severity increased, graft flow increased, pulsatility index decreased, and proportion of patients with systolic reverse flow increased. In mild coronary artery stenosis, the chance of flow competition between the native coronary artery and the bypass graft increased.

Cited by 60 publications

References 12 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

Development of a Shape‐Memory Tube to Prevent Vascular Stenosis

Off-pump coronary artery bypass grafting in left main stem stenosis: outcomes, concerns and controversies

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