Role of graft flow measurement technique in anastomotic quality assessment in minimally invasive CABG

Jaber, Saad F.; Koenig, Steven C.; BhaskerRao, Bobby; VanHimbergen, Daniel J.; Cerrito, Patricia B.; Ewert, Daniel J.; Gray, Laman A.; Spence, Paul A.

doi:10.1016/s0003-4975(98)00752-8

Cited by 64 publications

(30 citation statements)

References 15 publications

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“…However, the TTF method is not perfect as it is possible to have a patent anastomosis with a low graft TTF or, conversely, a partially compromised anastomosis with a high graft TTF. Moreover, graft TTF may not change significantly until graft stenosis is greater than 75% (10). Therefore, absolute TTF values must be interpreted in conjunction with the pulsatile index (PI) and the diastolization of the flow curve (DF) as well as patient characteristics (graft characteristics, coronary diffuse disease, impaired vascular bed, and competitive flow) (11).…”

Section: Introductionmentioning

confidence: 99%

Intra-operative Graft Blood Flow Measurements for Composite and Sequential Coronary Artery Bypass Grafting

et al. 2014

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Objectives Intraoperative assessment of coronary artery bypass grafts (CABG) anastomotic quality can be performed using transit-time flowmetry (TTF). The aim of this study was to compare on- versus off-pump coronary graft TTF and early postoperative outcomes. Materials and methods Between January 2009 and January 2010, 521 distal graft flows were assessed using TTF measurements in 253 consecutive patients undergoing primary isolated CABG surgery. Data were analyzed using multilevel models accounting for clustering among surgeons and grafts performed in the same patient. Results Mean age was 66 ± 10 years and 22% were female (n = 55) with 34% diabetics (n = 86) and 40% pre-operative myocardial infarction (MI) (n = 101). The surgeries were performed off-pump in 67% (n = 170) with sequential vein grafts in 57% (n = 144) of patients. Off-pump patients had higher pre-operative left ventricular ejection fractions (LVEF), fewer urgent surgeries, fewer distal anastomoses, and fewer sequential vein grafts (all p<0.001). Intra-operative coronary graft TTF measurements were lower in sequential vein grafts performed off-pump versus on-pump. More patients in the on-pump group needed milrinone or dobutamine 24-48 h postoperatively (p = 0.005). Independent predictors of lower TTF included female gender and off-pump surgery, whereas predictors of better TTF were pre-operative MI, larger coronary diameter at the site of the distal anastomosis, and sequential vein grafting. Conclusions Lower intra-operative TTF measurements were found in sequential vein grafts in offpump CABG. However, off-pump patients experienced similar short-term outcomes compared to on-pump patients.

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Section: Introductionmentioning

confidence: 99%

Intra-operative Graft Blood Flow Measurements for Composite and Sequential Coronary Artery Bypass Grafting

et al. 2014

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“…In conventional coronary artery bypass grafting (CABG), several techniques have been described to intra-operatively assess anastomotic quality including: graft flow measurement [8], epicardial ultrasound imaging [4,9,10], and fluorescence imaging [11]. All these techniques have one or more features that limit or prohibit their use in TECAB.…”

Section: Anastomotic Quality Controlmentioning

confidence: 99%

Robot-assisted 13 MHz epicardial ultrasound for endoscopic quality assessment of coronary anastomoses

Budde

Dessing

Meijer

et al. 2004

Interactive Cardiovascular and Thoracic Surgery

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In totally endoscopic coronary artery bypass surgery, intra-operative assessment of anastomotic quality is needed. We evaluated the endoscopic application of epicardial ultrasound to visualize the coronary anastomosis and detect a construction error. In 8 pigs (71-78kg), 16 internal mammary artery to left anterior descending coronary artery anastomoses were constructed conventionally, either correctly (n=8) or incorrectly with a suture cross-over construction error (n=8). A 13MHz mini-transducer (15x9x6mm) was introduced through a port and manipulated by the 'da Vinci' system. The chest was re-opened and scanning repeated manually. Postoperatively, macroscopic inspection served as reference and the intra-operative ultrasound images were scored as 'correct' or 'construction error' by two blinded observers. All anastomoses were scored accurately by both observers. One anastomosis constructed to be correct was scored as construction error, due to narrowing of the outflow corner and anastomotic orifice. Ultrasound images corresponded with macroscopic inspection. Closed-chest scan time was about 1.5 times longer than open-chest scan time, 176s (88-464) (median, range) versus 125s (75-314) (P=0.01), respectively. Closed-chest epicardial 13MHz ultrasound scanning required a median of 3min and enabled discrimination between correctly and incorrectly constructed coronary anastomoses.

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“…In an experimental study, Jaber et al created off pump LIMA to LAD anastomosis in dogs 10 . Stenosis of varying degrees was produced in the anastomoses by putting additional sutures.…”

Section: Commentmentioning

confidence: 99%

Evaluation of coronary artery bypass grafts by intraoperative transit time flow measurement

Goel¹,

Dubey²,

Makker³

et al. 2003

Indian J Thorac Cardiovasc Surg

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consecutive patients undergoing CABG at our institute routinely underwent flow measurements of all bypass grafts using the Medi-Stim Butterfly BF 4004 transit time flowmeter.The preoperative patient characteristics are enlisted in table 1. Operative techniqueIntra-operative trans-esophageal echocardiography (pre-operative and post-operative) was used in all cases to assess the ventricular functions and regional wall motion. After median sternotomy, left internal mammary artery (LIMA) was harvested. In patients where cardiopulmonary bypass (CPB) was used, both antegrade and retrograde cardioplegia was used for myocardial protection. Off pump coronary artery bypass (OPCAB) was performed in 67 cases. Grafting was attempted on all vessels more than 1.0 mm in size and more than 75% obstruction. The proximal anastomoses were performed after the release of the cross clamp using a side biting clamp.Once the anastomoses were completed, the graft flows were measured. The systolic blood pressure was Abstract Background: This study was conducted to evaluate the efficacy of transit time flowmetery in determining graft related problems per-operatively while performing coronary artery bypass grafting. Method: From May 2001 to January 2002 transit time flowmetery was performed on 442 grafts in 185 consecutive patients. A fixed protocol was used to assess the flow indices. Grafts were considered blocked if the pulsatility index was more than 5 and a systolic spike was present.Results: Abnormal flowmetery was observed in 10 grafts (2.26%). The mean flows for left internal mammary artery, radial and saphenous vein grafts were 28.24±18.12 ml/min., 37.57±21.81 ml/min., 28.8±17.17 ml/min. respectively. Nine of these grafts were revised with return of flow indices to normal. In one case the native vessel was small and of poor quality and revision was not possible. The 30-day mortality was 1.08%. There was no death attributable to graft malperfusion.Conclusion: Transit time flowmeter is a valuable tool in detecting graft related problems per-operatively. These problems can be corrected immediately thus reducing mortality and morbidity. (Ind J Thorac Cardiovasc Surg, 2003; 19: 108-112)

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Role of graft flow measurement technique in anastomotic quality assessment in minimally invasive CABG

Cited by 64 publications

References 15 publications

Intra-operative Graft Blood Flow Measurements for Composite and Sequential Coronary Artery Bypass Grafting

Intra-operative Graft Blood Flow Measurements for Composite and Sequential Coronary Artery Bypass Grafting

Robot-assisted 13 MHz epicardial ultrasound for endoscopic quality assessment of coronary anastomoses

Evaluation of coronary artery bypass grafts by intraoperative transit time flow measurement

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