Predictive value of intraoperative transit-time flow measurement for short-term graft patency in coronary surgery

Objective Transit time flow measurement (TTFM) is a method used to assess intraoperative blood flow after vascular anastomoses. Angiography represents the criterion standard for the assessment of graft patency after coronary artery bypass grafting (CABG). The purpose of this study was to compare flow measurements from TTFM to diagnostic angiography. Methods From October 9, 2009, to April 30, 2012, a total of 259 patients underwent robotic-assisted CABG procedures at a single institution. Of these, 160 patients had both TTFM and either intraoperative or postoperative angiography of the left internal mammary artery to the left anterior descending coronary artery graft. Transit time flow measurements were obtained after completion of the anastomosis and after administration of protamine before chest closure. Transit time flow measurement assessment included pulsatility index, diastolic fraction, and flow (milliliters per minute). Angiograms were graded according to the Fitzgibbon criteria. The patients were grouped according to angiographic findings, with perfect grafts defined as FitzGibbon A and problematic grafts defined as either Fitzgibbon B or O. Results Overall, there were 152 (95%) of 160 angiographically perfect grafts (FitzGibbon A). Of the eight problematic grafts, five were occluded (Fitzgibbon O) and three had significant flow-limiting lesions (FitzGibbon B). Two patients had intraoperative graft revision after completion angiography, one had redo CABG during the same hospitalization, and five were treated with percutaneous coronary intervention. A significant difference was seen in mean ± SD flow (34.3 ± 16.8 mL/min vs 23.9 ± 12.5 mL/min, P = 0.033) between patent and nonpatent grafts but not in pulsatility index (1.98 ± 0.76 vs 1.65 ± 0.48, P = 0.16) or diastolic fraction (73.5% ± 8.45% vs 70.9% ± 6.15%, P = 0.13). Conclusions Although TTFM can be a useful tool for graft assessment after CABG, false negatives can occur. Angiography remains the criterion standard to assess graft patency and quality of the anastomosis after CABG.

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Intraoperative Transit-Time Flow Measurement is Not Altered in Venous Bypass Grafts Covered by the eSVS Mesh

Innovations Technology and Techniques in Cardiothoracic and Vascular Surgery ◽

10.1097/imi.0b013e31828e5d1e ◽

2013 ◽

Vol 8 (1) ◽

pp. 37-41 ◽

Cited By ~ 3

Author(s):

Robert W. Emery ◽

Eric Solien

Keyword(s):

Transit Time ◽

Flow Measurement ◽

Graft Patency ◽

Dobutamine Stress ◽

Coronary Vein ◽

Venous Bypass ◽

Off Pump ◽

Vein Grafts ◽

Flow Parameters ◽

Time Flow

Objective The aim of this study was to determine whether the eSVS Mesh interferes with transit-time flow measurement (TTFM) assessing intraoperative coronary vein graft patency. Methods In four swine undergoing off-pump bypass grafting to the anterior descending coronary artery, five TTFMs were sequentially obtained on meshed and bare grafts at baseline and under Dobutamine stress at five separate locations on the graft in each animal. The Medistim VeriQ was used for TTFM. The grafts were examined for patency after the swine were killed. Results There was no difference in hemodynamics or TTFM either at baseline or under Dobutamine stress between the eSVS Mesh covered and uncovered grafts. Dobutamine, however, significantly increased hemodynamics and graft flow parameters measured from baseline. Conclusions The eSVS Mesh does not interfere with Doppler flow measurement in covered coronary vein grafts.

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Preoperative Angiography and Intraoperative Transit Time Flow Measurement to Detect Coronary Graft Patency in Reoperations: An Integrated Approach

Angiology ◽

10.1177/000331970005100910 ◽

2000 ◽

Vol 51 (9) ◽

pp. 777-780 ◽

Cited By ~ 3

Author(s):

Giuseppe D'Ancona ◽

Hratch Karamanoukian ◽

Marco Ricci ◽

Jacob Bergsland ◽

Tomas A. Salerno ◽

...

Keyword(s):

Transit Time ◽

Flow Measurement ◽

Integrated Approach ◽

Graft Patency ◽

Time Flow

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Coronary Artery Bypass Grafting Transit-Time Flow Measurement: Graft Patency and Clinical Outcomes

The Annals of Thoracic Surgery ◽

10.1016/j.athoracsur.2020.12.011 ◽

2020 ◽

Author(s):

Jacquelyn A. Quin ◽

Mohammad Noubani ◽

Jessica Y. Rove ◽

John E. Krstacic ◽

Brack Hattler ◽

...

Keyword(s):

Coronary Artery ◽

Coronary Artery Bypass Grafting ◽

Clinical Outcomes ◽

Coronary Artery Bypass ◽

Transit Time ◽

Flow Measurement ◽

Artery Bypass ◽

Graft Patency ◽

Bypass Grafting ◽

Time Flow

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The Accuracy of Transit Time Flow Measurement in Predicting Graft Patency after Coronary Artery Bypass Grafting

Innovations Technology and Techniques in Cardiothoracic and Vascular Surgery ◽

10.1177/155698451300800606 ◽

2013 ◽

Vol 8 (6) ◽

pp. 416-419

Author(s):

Patrick F. Walker ◽

William T. Daniel ◽

Emmanuel Moss ◽

Vinod H. Thourani ◽

Patrick Kilgo ◽

...

Keyword(s):

Coronary Artery ◽

Coronary Artery Bypass Grafting ◽

Coronary Artery Bypass ◽

Transit Time ◽

Flow Measurement ◽

Artery Bypass ◽

Graft Patency ◽

Bypass Grafting ◽

Artery Bypass Grafting ◽

Time Flow

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Intraoperative graft verification in coronary surgery: increased diagnostic accuracy adding high-resolution epicardial ultrasonography to transit-time flow measurement

European Journal of Cardio-Thoracic Surgery ◽

10.1093/ejcts/ezt580 ◽

2013 ◽

Vol 45 (3) ◽

pp. e41-e45 ◽

Cited By ~ 34

Author(s):

Gabriele Di Giammarco ◽

Carlo Canosa ◽

Massimiliano Foschi ◽

Roberto Rabozzi ◽

Daniele Marinelli ◽

...

Keyword(s):

High Resolution ◽

Diagnostic Accuracy ◽

Transit Time ◽

Flow Measurement ◽

Coronary Surgery ◽

Time Flow

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Relation of waveform of transit-time flow measurement and graft patency in coronary artery bypass grafting

Journal of Thoracic and Cardiovascular Surgery ◽

10.1016/j.jtcvs.2007.04.054 ◽

2007 ◽

Vol 134 (3) ◽

pp. 789-791 ◽

Cited By ~ 6

Author(s):

Atsutoshi Hatada ◽

Tatsuya Yoshimasu ◽

Masahiro Kaneko ◽

Mitsumasa Kawago ◽

Mitsuru Yuzaki ◽

...

Keyword(s):

Coronary Artery ◽

Coronary Artery Bypass Grafting ◽

Coronary Artery Bypass ◽

Transit Time ◽

Flow Measurement ◽

Artery Bypass ◽

Graft Patency ◽

Bypass Grafting ◽

Artery Bypass Grafting ◽

Time Flow

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Determinants of successful arteriovenous fistulae creation including intraoperative transit time flow measurement

The Journal of Vascular Access ◽

10.1177/1129729819874312 ◽

2019 ◽

Vol 21 (3) ◽

pp. 387-394 ◽

Cited By ~ 1

Author(s):

Alexander Meyer ◽

Eberhard Flicker ◽

Sascha T König ◽

Anne Sabine Vetter

Keyword(s):

Blood Flow ◽

Physical Examination ◽

Arteriovenous Fistula ◽

Transit Time ◽

Predictive Value ◽

Flow Measurement ◽

Arteriovenous Fistulae ◽

Time Flow ◽

First Choice ◽

Fistula Maturation

Background: The prevalence of hemodialysis patients is increasing, and it is important to create the arteriovenous fistula as early as possible to avoid hemodialysis by central venous catheter. International guidelines recommend arteriovenous fistula as the vascular access of first choice. Arteriovenous fistulae are associated with a failure rate of 23%. The success of an arteriovenous fistula can be evaluated intraoperatively by physical examination and by measuring the blood flow. Objectives: The aim of the study is to describe the predictive value of various factors for fistula maturation in the context to the current literature. Methods: We report on a prospective cohort study of 41 patients, undergoing a primary arteriovenous fistula at the upper extremity. The primary endpoint of the study was the successful fistula maturation after 6 weeks. Results: The intraoperative measurement of the blood flow in the outflow vein has been identified as the unique significant parameter for the fistula maturation. Conclusion: The predictive value of intraoperative flow measurement is superior to intraoperative physical examination and could help reduce the fistula dysmaturation rate. Intraoperative transit time flow measurement is an easy method and can be used to predict successful fistula maturation in a high percentage rate.

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