The impact of intraoperative transit time flow measurement on the results of on-pump coronary surgery

Becit, Necip; Erkut, Bilgehan; Ceviz, Münacettin; Ünlü, Yahya; Çolak, Abdürrahim; Koçak, Hikmet

doi:10.1016/j.ejcts.2007.04.037

Cited by 54 publications

(50 citation statements)

References 14 publications

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“…Two out of three grafts (23.1%) anastomosed to the end branches of the right coronary system were patent follow-up but had a significantly lower intraoperative flow that observed in the overall collective (40 AE 16 ml/min in comparison to the average flow of 71.0 AE 59.5 ml/min in the total collective). This observation is not congruent with the findings described in the literature for autologous grafts where patency is superior in high-flow grafts [6]. One explanation for the finding that low-flow NRIMA grafts have a better mid-term patency than high-flow grafts may be the observation described from Ostapczuk et al [7] in the calf model, where a chronic rejection of the NRIMA was observed.…”

Section: Discussioncontrasting

confidence: 56%

The Shelhigh No-React® bovine internal mammary artery: a questionable alternative conduit in coronary bypass surgery?☆

Englberger

Noti

Immer

et al. 2008

European Journal of Cardio-Thoracic Surgery

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Background: Increasing age and comorbidities among patients undergoing coronary artery bypass surgery (CABG) stimulates the exhaustive research for alternative grafts. No-React W treatment should render the tissue resistant against degeneration and reduce early inflammatory response. The aim of the present study was an invasive assessment of the patency of No-React W bovine internal mammary artery (NRIMA grafts) used as bypass conduit in CABG surgery. Patients and methods: Nineteen NRIMA grafts were used in 17 patients (2.9%) out of a total of 572 patients undergoing CABG surgery within a 12-month period. All intraoperative data were assessed and in-hospital outcome was analysed. Follow-up examination was performed 7.0 AE 4.0 months after initial surgery, including clinical status and coronary angiography to assess patency of the NRIMA grafts. Results: Average perioperative flow of all NRIMA grafts was 71 AE 60 ml/min. One patient died in hospital due to a multi-organ failure. Four patients refused invasive assessment. Follow-up was complete in 12 patients with overall 13 NRIMA grafts. Nine NRIMA grafts (69.2%) were used for the right coronary system, two NRIMA grafts (15.4%) on the LAD and two on the circumflex artery. Graft patency was 23.1% and was independent of the intraoperative flow measurement. Conclusions: NRIMA grafts show a very low patency and cannot be recommended as coronary bypass graft conduits. Patency was independent of the perioperative flow, assessed by Doppler ultrasound. Because of this unsatisfying observation, this type of graft should be utilised as a last resource conduit and used only to revascularise less important target vessels, such as the end branches of the right coronary artery. #

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Section: Discussioncontrasting

confidence: 56%

The Shelhigh No-React® bovine internal mammary artery: a questionable alternative conduit in coronary bypass surgery?☆

Englberger

Noti

Immer

et al. 2008

European Journal of Cardio-Thoracic Surgery

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“…4). Этому принципу мы следуем у всех пациентов, неза-висимо от методики реваскуляризации, что, по дан-ным литературы, позволяет статистически досто-верно снизить частоту инфаркта миокарда и госпи-тальной летальности [11,12].…”

Section: оперативная техникаunclassified

Surgical Specifics of Off-Pump Myocardial Revascularization by Opcab Method

Rukosujew¹,

Martens²

2015

Russ J Cardiol

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Метод коронарного шунтирования без остановки кровообращения сегодня является альтернативным методом по отношению к традиционной технике, особенно для пациентов старшего возраста и с высоким риском. Успешная работа с этим методом зависит от опыта хирурга, оперирующей группы и стандартизации всех этапов анестезиологической и хирургической помощи в периоперационном периоде. Эта статья описывает периоперационные осо-бенности в нашем учреждении и наше видение роли и места ОРСАВ в лечении пациентов с коронарной болезнью сердца. Российский SURGICAL SPECIFICS OF OFF-PUMP MYOCARDIAL REVASCULARIZATION BY OPCAB METHODRukosujew A., Martens s.opcAb (off-pump coronary artery bypass) remains nowadays an alternative method to traditional on-pump technique of the myocardial revascularization especially in high-risk and elderly patients. A successful adoption of this technique depends on a surgeon's experience, a cooperative team and standardization of all steps in anesthesiological and surgical procedures in perioperative period. this article describes the perioperative policy adopted in our institution and our view on the role and place of opcAb in the treatment of patients with coronary heart disease. Off-pump coronary artery bypass (OPCAB), как метод хирургического лечения ишемической болезни сердца при многососудистом поражении, стал широко применяться в конце 90-х годов и ныне явля-ется альтернативной техникой традиционным опера-циям на коронарных сосудах с использованием искусственного кровообращения (ИК). Хотя OPCAB выполняется через полную срединную стернотомию, последний относится всё же к минимально инвазив-ным вмешательствам и позволяет избежать или суще-ственно снизить целый ряд осложнений, связанных с применением ИК, кардиоплегической остановкой сердца, манипуляциями на аорте [1][2][3][4][5][6]. RussОсобенно выигрывают при использовании этой методики пожилые пациенты с диффузными атероскле-ротическими изменениями аорты, периферических и сонных артерий, хроническими обструктивными забо-леваниями легких, инсультом в анамнезе, почечной недостаточностью и сниженной фракцией выброса [7][8][9].Определяющую роль в успехе операции играет слаженная работа хирурга и анестезиолога, а также их личный опыт и опыт всей операционной бригады с использованием отработанной, т. е. стандартизиро-ванной, оперативной техники.Хотя техника OPCAB признана многими хирур-гами и используется практически во всех кадиохирур-гических клиниках, все же в мире только приблизи-тельно 1/5 реваскуляризаций миокарда осуществля-ется без ИК [10].Общие пре-и интраоперативные предпосылки Ведение наркоза при операции по методике OPCAB направлено на ранюю экстубацию пациента на опера-ционном столе. Для этого в нашей клинике использу-ются препараты короткого действия, что позволяет предотвратить в первую очередь легочные осложнения и способствует ранней мобилизации пациента, осо-бенно в пожилом возрасте. После индукции в наркоз всем пациентам устанавливают катетер Swan -Ganz, за исключением тех, у кого реваскуляризация ограни-чивается ареалом ПМЖВ и её диагон...

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“…Teknik olarak düzeltilebilecek bir hatan n neden oldu u yetersiz greft ak mlar n n saptanmas ve düzeltilmesi, perioperatif morbidite ve mortaliteyi azaltacak, inkomplet revaskülarizasyonu önleyecektir. Kalp cerrahlar için CABG operasyonunda yap lan anastomozlar n kalitatif olarak direkt de erlendirilmesi çok önem ta maktad r. [1][2][3][4][5][6] Bu çal mada, klini imizde yap lan CABG operasyonlar nda kullan lan greftlerin intraoperatif Transit Time Ak m Ölçüm (TTFM) Cihaz ile de erlendirilmesi, greftlerden geçen ak m miktarlar n n ölçülmesi ve yetersiz greft ak m saptand nda, cerrahi prosedürün gözden geçirilerek, hatan n düzeltilmesi amaçland .…”

Section: G Runclassified

“…Bu ölçümlerimiz literatürdeki di er çal malarla da benzerlik göstermektedir. [6] Bu çeli kiyi u ekilde aç klayabiliriz. Sa koroner sistemde, greftler nadiren proksimal k s m veya sa ventriküler dala konulmaktad r. Greftlerin büyük ço unlu u ise sa koroner arterin distal k sm na, arka inen artere (PDA) veya arka-yan artere (PLA) konulmaktad r. Proksimalde kritik lezyonu olan sa koroner sisteme konulan bu greftler de genellikle sistolik intramyokardiyal bas nc yüksek olan sol ventrikülü veya septumu diyastolde kanland rmaktad r.…”

Section: Tablo 4 Hastalar N Cerrahi Sonuçlarunclassified

The Evaluation Of Arterial And Venous Grafts With Intraoperative Flowmeter Techniques In Coronary Artery Bypass Grafting Operations

Canbaz¹,

Unal²,

Duran³

2010

TUTFD

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© Trakya Üniversitesi T p Fakültesi Dergisi. AVES Yay nc l k taraf ndan bas lm t r. Her hakk sakl d r. © Medical Journal of TrakyaSonuç: Transit Time Flow Ölçümü (TTFM), cerrahi esnas ndaki teknik yetersizliklerin saptanmas nda önemli katk lar olan bir yöntemdir. Perioperatif olarak greft yetersizli inin saptanmas ile küçük giri imlerle, genellikle hatan n düzeltilmesi ve yeterli greft ak m n n sa lanmas mümkün olabilmektedir.Anahtar sözcükler: Koroner arter bypass cerrahisi; internal mammaryan arter; safen ven; transit time ak m ölçer; greft revizyonu. Objective:The purpose of this study was to evaluate the coronary artery bypass grafts with Transit Time Flowmeter (TTFM). Material and Methods:Fifty-nine patients who were scheduled for coronary artery bypass graft (CABG) surgery were included in the study. Coronary artery bypass anastomoses were performed using the left internal mammary artery (LIMA) and saphenous vein. At the end of the cardiopulmonary bypass, graft flow (ml/min), pulsatility index (PI), flow curve and diastolic filling percentage (DF%) of each graft were assessed with TTFM.Results: Mean graft number of the patients was 3.25±0.8. We assessed the patency of a total of 187 grafts using TTFM. Highest mean flow was 55.5 ml/min in aorta-RCA grafts and lowest mean flow was 37.6 ml/ min in aorta-diagonal grafts. Revision was required for two grafts (3.38%) in two patients based on inadequate TTFM findings. Conclusion:Transit time flowmeter is an important technique that provides the detection of technical errors during surgery. With the detection of graft failure intraoperatively, revision of the graft and restoration of blood flow could be performed.

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The impact of intraoperative transit time flow measurement on the results of on-pump coronary surgery

Abstract: We believe that TTFM seems to be a crucial tool for deciding if a graft is well-functioning or not, and it allows for improvement of graft failure during operation. Our results suggest that detection of graft dysfunction intraoperatively by TTFM improves the surgical outcome.

Cited by 54 publications

References 14 publications

The Shelhigh No-React® bovine internal mammary artery: a questionable alternative conduit in coronary bypass surgery?☆

The Shelhigh No-React® bovine internal mammary artery: a questionable alternative conduit in coronary bypass surgery?☆

Surgical Specifics of Off-Pump Myocardial Revascularization by Opcab Method

The Evaluation Of Arterial And Venous Grafts With Intraoperative Flowmeter Techniques In Coronary Artery Bypass Grafting Operations

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