Intraoperative bypass graft flow in intra-aortic balloon pump–supported patients: Differences in arterial and venous sequential conduits

Abstract

In this analysis, use of intra-aortic balloon pump was associated with improved diastolic and mean blood flow in bypass grafts. Arterial and sequential grafts were associated with greater improvements in blood flow and surplus graft flow. Graft failure was associated with poor transit-time flow results, high pulsatility index values, and absent surplus graft flow.

Intra-aortic balloon pumping recruits graft flow reserve by lowering coronary resistances

“…The average maximum diastolic flow and mean flow, however, significantly improved with IABP assistance (Table 2). Waveform analysis of well-functioning grafts revealed the increase in blood flow observed with IABP resulted from an increase in diastolic flow, as previously reported [4]. During both 1:1 IABP and IABP cessation, TTF analysis was accomplished at the same systolic arterial pressures (105.7 ± 12.8 mmHg and 105.5 ± 12.9 mmHg, respectively; P = .281).…”

“…Indications for preoperative IABP use were 3-vessel disease and ≥2 of the following: preoperative left ventricular ejection fraction ≤30%, left main coronary artery stem stenosis N 90%, chronic occlusion of the 3 main coronary trunks (left anterior descending [LAD], right, and circumflex coronary arteries), tight stenosis (N 95%) of the proximal LAD (before the first septal or diagonal branch), proximal tight stenosis (N95%) of a dominant right coronary artery (RCA) with remote branches for the posterior wall of the left ventricle, unstable angina despite the use of intravenous nitrates and heparin, recent (b7 days) acute MI of the anterolateral left ventricular wall, and acute ongoing angina or MI with failed percutaneous coronary intervention (PCI) [4].…”

“…Transit-time flow (TTF) measurements were interpreted as previously reported [4]. Data from single, sequential, arterial, and venous conduits were recorded.…”

“…Percent improvements in maximum, mean, and minimum blood flows were calculated. The GFR was calculated from the mean flow occurring during 1:1 IABP support divided by the mean flow during temporary cessation [4].…”

“…Moreover, the preoperative use of IABP can have a beneficial effect on mortality and morbidity in high-risk patients undergoing CABG [2], and the intraoperative use of IABP correlates with improved graft function [3]. Finally, IABP has been associated with improved diastolic and mean blood flow in functioning bypass grafts [4].…”