Single versus sequential saphenous vein grafting of the circumflex system: A flowmetric study

Pezzo, Francesco; Esposito, Antonio; Impiombato, Barbara; Comi, Maria Caterina; Polistina, Massimo; Renzulli, Attilio

doi:10.1080/14017430701283864

Cited by 19 publications

(18 citation statements)

References 19 publications

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“…Increased graft flow rate has been associated with decreased SVG intimal proliferation (15). Some series have reported better TTF measurements (16,17) or patency (15,18) results with sequential grafting strategy compared to single graft while others have not (19)(20)(21). A meta-analysis of 12 studies comparing the patency of sequential and individual vein grafts concluded that the mid-and long-term patency of sequential vein grafts were superior to single vein grafts (14).…”

Section: Coronary Graft Flow Measurementmentioning

confidence: 99%

“…Conversely, in the off-pump group: A) local coronary occlusions of short duration probably are unable to trigger a "vasodilation effect"; B) vasopressors used to stabilize hemodynamics during off-pump surgery can constrict the coronary vascular bed; and 3) coronary snaring has been associated with microthrombosis, atherosclerotic plaque rupture, focal endothelial denudation, distal embolization, and injury to target vessel branches (26). Intracoronary shunting may protect against back wall suturing, another cause of early graft failure, however it is also associated with more technically demanding anastomoses and intimal injury (17). In addition to off-pump surgery, female gender was identified as a predictor of lower coronary graft TTF measurements.…”

Section: Coronary Graft Flow Measurementmentioning

confidence: 99%

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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: Coronary Graft Flow Measurementmentioning

confidence: 99%

Section: Coronary Graft Flow Measurementmentioning

confidence: 99%

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

et al. 2014

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“…Therefore TTF may help us to understand subtle physiological differences between arterial and venous grafts, which can then have an impact on the fate of the grafts. It has been demonstrated that the principal determinant of the patency rate of CABG in the late postoperative period is the flow rate throughout the graft [21]: Faulkner reported a strict association between an increased flow rate and a less intimal proliferation [8]; Rittgers demonstrated a reverse relationship between the flow rate and intimal proliferation [22]. The better TTF and GFR results of RA grafts may be the explanation of a higher patency rate compared to SV, already reported by some Authors [23].…”

Section: Discussionmentioning

confidence: 99%

Radial artery graft flowmetry is better than saphenous vein on postero-lateral wall

Santarpino

Cristodoro

Scalas

et al. 2010

International Journal of Cardiology

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“…TTFM has been reported as important for determining the success of grafts during surgery [22] and for predicting the risk of graft failure after surgery [21], making TTFM the most widely used method of intraoperative graft quality control in patients undergoing CABG surgery [3][4][5][6][7][8]. Prior to this study, however, the perioperative factors affecting TTFM during CABG surgery had not been determined, making this study one of the first to assess perioperative factors affecting flow measurements in graft vessels.…”

Section: Discussionmentioning

confidence: 99%

“…Transit-time flow measurement (TTFM), which utilizes ultrasound to measure flow velocity in blood vessels, is frequently used for intraoperative assessment of graft quality in patients undergoing coronary artery bypass graft (CABG) surgery [3][4][5][6][7][8]. TTFM is a noninvasive, easy-to-use method of measuring graft flow velocity in real time, does not require complex equipment, and provides numerical results [9,10].…”

Section: Introductionmentioning

confidence: 99%

The Effect of Whole Blood Viscosity on Intraoperative Graft Flow during Coronary Artery Bypass Graft Surgery: An Observational Pilot Study

Lee¹,

Jo²,

Kim³

et al. 2019

Preprint

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Running titleEffect of blood viscosity on intraoperative graft flow Preprints (www.preprints.org) | NOT PEER-REVIEWED | Posted: AbstractBackground: Transit-time flow measurement (TTFM) is frequently used to evaluate intraoperative quality control during coronary artery bypass grafting (CABG). Although TTFM has the ability to assess graft failure intraoperatively, the perioperative factors affecting TTFM during CABG surgery remain poorly understood. Methods:Patients who underwent CABG surgery at a single institution between July 2016 and May 2018 were prospectively evaluated. Patients' demographic characteristics, previous medical history, Euroscore, the results of preoperative blood tests, and intraoperative data were recorded. TTFM and blood viscosity were measured hemodynamically, and mean flow (mL/min) and pulsatility index (PI) were recorded. Arterial blood gas was analyzed immediately after anastomosis of the left internal mammary artery (LIMA) to the left descending artery (LAD) and before sternal closure. Factors associated with TTFM were assessed by multiple linear regression analysis. Results:Of the 62 patients who underwent CABG surgery during the study period, 57 were evaluated, including 49 who underwent off-pump and eight who underwent on-pump surgery. Blood viscosity was not significantly associated with TTFM (p > 0.05). However, TTFM was significantly associated with body mass index (BMI), systolic blood pressure, and cardiac index (p < 0.05 each).Conclusions: Blood viscosity was not significantly associated with intraoperative graft flow. Blood flow of graft vessels, however, was significantly associated with BMI, systolic blood pressure, and cardiac index. KeywordsBlood viscosity, Transit-time flow measurement, Coronary artery bypass surgery Preprints (www.preprints.org) | NOT PEER-REVIEWED | Posted:

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Single versus sequential saphenous vein grafting of the circumflex system: A flowmetric study

Abstract: SeqSV-CABG showed higher TTF flows, with no incremental risk for perioperative morbidity. Higher flows and graft flow reserve may allow lower treatment failure at mid-term follow-up.

Cited by 19 publications

References 19 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

Radial artery graft flowmetry is better than saphenous vein on postero-lateral wall

The Effect of Whole Blood Viscosity on Intraoperative Graft Flow during Coronary Artery Bypass Graft Surgery: An Observational Pilot Study

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