Intraoperative graft assessment during coronary artery bypass surgery

Fukui, Toshihiro

doi:10.1007/s11748-014-0512-9

Cited by 9 publications

(7 citation statements)

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“…BF expresses the percentage of graft blood flow redirected to the graft and is measured during one complete cardiac cycle. If the percentage of the reverse flow area is more than 3% of total flow, this is considered to be a positive value of BF [14,17]. The BF is registered as the area below the zero line ( Figure 2).…”

Section: Revascularization and Graft Flow Measurementmentioning

confidence: 99%

Correlation between Preoperative Coronary Artery Stenosis Severity Measured by Instantaneous Wave-Free Ratio and Intraoperative Transit Time Flow Measurement of Attached Grafts

et al. 2020

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Background and Objectives: To assess the correlation between the degree of target coronary artery stenosis measured by instantaneous wave-free ratio (iFR) and the intraoperative transit time flow measurement (TTFM) of attached grafts as well as evaluate flow competition between the native coronary artery and the attached graft according to the severity of stenosis. Materials and Methods: In total, 89 grafts were subjected to intraoperative transit time flow measurement after coronary artery bypass grafting (CABG) in 25 patients with multivessel coronary artery disease (CAD). The iFR was evaluated for all coronary arteries with grafts. The coronary artery stenoses were divided into three groups based on the iFR value: iFR < 0.86 (group 1); iFR 0.86–0.90 (group 2); and iFR > 0.90 (group 3). Results: The mean graft flow (MGF) was 46.9 ± 18.4 mL/min for group 1, 45.3 ± 20.9 mL/min for group 2, and 31.3 ± 18.5 mL/min for group 3. A statistically significant difference was confirmed between groups 1 and 3 (p = 0.002) and between groups 2 and 3 (p = 0.025). The pulsatility index (PI) was 2.49 ± 1.20 for group 1, 2.66 ± 2.13 for group 2, and 4.70 ± 3.66 for group 3. A statistically significant difference was found between groups 1 and 3 (p = 0.006) and between groups 2 and 3 (p = 0.032). Backward flow was detected in 7.5% of grafts for group 1, in 16.6% of grafts for group 2, and in 16% of grafts for group 3. A statistically significant difference was found between groups 1 and 2 (p = 0.025) and between groups 1 and 3 (p = 0.029). Conclusions: The iFR is a useful tool for predicting the impact of competitive flow observed between a native artery and an attached graft. The effect of competitive flow significantly increases when the graft is attached to a vessel with mild coronary stenosis. In a coronary artery where the iFR was not hemodynamically significant, the MGF was lower, the PI was higher, and a larger proportion of grafts with backward flow (BF) was detected compared to when there was significant stenosis (iFR < 0.86).

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Section: Revascularization and Graft Flow Measurementmentioning

confidence: 99%

Correlation between Preoperative Coronary Artery Stenosis Severity Measured by Instantaneous Wave-Free Ratio and Intraoperative Transit Time Flow Measurement of Attached Grafts

et al. 2020

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“…Perioperative MI can be related to graft-related causes (early graft failure, coronary artery thrombosis and postoperative spasm) along with non-graft related such as incomplete myocardial revascularisation, inadequate myocardial protection or preoperative ischaemic injury 2 3. Early graft failure after CABG is reported in up to 12% of grafts4 (left internal mammary artery (LIMA) 1%–2.5%; saphenous vein graft (SVG) 3%–12%, radial artery 3%–4%) when evaluated by intraoperative angiography; however, only a minority are symptomatic 5 6. Therefore, diagnosis of early graft failure is still a clinical challenge, particularly because elevation of cardiac biomarkers is ubiquitous after CABG and both ECG changes and echocardiographic wall motion abnormalities are not highly specific 3 7–9.…”

Section: Introductionmentioning

confidence: 99%

Management of perioperative myocardial ischaemia after isolated coronary artery bypass graft surgery

Sef

Szavits-Nossan²,

Predrijevac³

et al. 2019

Open Heart

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ObjectivesUpdated knowledge about perioperative myocardial ischaemia (MI) after coronary artery bypass grafting (CABG) and treatment of acute graft failure is needed. We analysed main factors associated with perioperative MI and effects of immediate coronary angiography-based treatment strategy on patient outcome.MethodsAmong 1119 consecutive patients with coronary artery disease who underwent isolated CABG between January 2011 and December 2015, 43 (3.8%) patients underwent urgent coronary angiography due to suspected perioperative MI. All the data were prospectively collected and retrospectively analysed. The primary endpoint was 30-day mortality; postoperative left ventricular ejection fraction) and major adverse cardiac events were secondary endpoints.ResultsOverall, 30-day mortality in patients with CABG was 1.4% while in patients who developed perioperative MI was 9% (4 patients). Angiographic findings included incorrect graft anastomosis, graft spasm, dissection, acute coronary artery thrombotic occlusion and ischaemia due to incomplete revascularisation. Emergency reoperation (Redo) was performed in 14 (32%), acute percutaneous coronary intervention (PCI) in 15 (36%) and conservative treatment (Non-op) in 14 patients. Demographic and preoperative clinical characteristics between the groups were comparable. Postoperative LVEF was significantly reduced in the Redo group (45% post-op vs 53% pre-op) and did not change in groups PCI (56% post-op vs 57% pre-op) and Non-op (58% post-op vs 57% pre-op).ConclusionsUrgent angiography allows identification of the various underlying causes of perioperative MI and urgent treatment when this is needed. Urgent PCI may be associated with improved clinical outcome in patients with early graft failure.

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“…Early graft failure rates are related to the graft type and invariably lower for arterial grafts, such as the left internal thoracic artery (1.0%-2.5%) and radial artery (3.0%-4.0%), and higher for saphenous vein grafts (3.0%-12%). 23…”

Section: Incidence Of Perioperative Myocardial Ischemiamentioning

confidence: 99%