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

AbstractTransit-time flow measurement (TTFM) has been increasingly applied to detect graft failure during coronary artery bypass grafting (CABG), because TTFM is less invasive, more reproducible, and less time consuming. Many authors have attempted to validate TTFM and to gain the clear cutoff values and algorithm in TTFM to predict graft failure. The TTFM technology has also been shown to be a useful tool to investigate CABG graft flow characteristics and coronary circulation physiology. It is important to recognize the practical roles of TTFM in the cardiac operating room by review and summarize the literatures.

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Transit-time flow measurement verifies patency of coronary artery grafts: An observational study

Heart Lung and Circulation ◽

10.1016/j.hlc.2014.12.044 ◽

2015 ◽

Vol 24 ◽

pp. e19-e20

Author(s):

Mohammad R. Azari ◽

Ajay Hirikannawar ◽

Hugh Wolfenden ◽

Bruce French ◽

Manish Jain ◽

...

Keyword(s):

Coronary Artery ◽

Observational Study ◽

Transit Time ◽

Flow Measurement ◽

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 ◽

10.1097/imi.0000000000000021 ◽

2013 ◽

Vol 8 (6) ◽

pp. 416-419 ◽

Cited By ~ 14

Author(s):

Patrick F. Walker ◽

William T. Daniel ◽

Emmanuel Moss ◽

Vinod H. Thourani ◽

Patrick Kilgo ◽

...

Keyword(s):

Coronary Artery ◽

Coronary Artery Bypass Grafting ◽

Transit Time ◽

Pulsatility Index ◽

Flow Measurement ◽

Artery Bypass ◽

Graft Patency ◽

Bypass Grafting ◽

Flow Measurements ◽

Time Flow

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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Enhancement of flow measurement for graft verification

Asian Cardiovascular and Thoracic Annals ◽

10.1177/0218492319881034 ◽

2019 ◽

Vol 27 (8) ◽

pp. 646-651

Author(s):

Yury Y Vechersky ◽

Vasily V Zatolokin ◽

Boris N Kozlov ◽

Aleksandra A Nenakhova ◽

Vladimir M Shipulin

Keyword(s):

Coronary Artery ◽

Transit Time ◽

Flow Measurement ◽

Artery Bypass ◽

Coronary Bypass ◽

Flow Measurements ◽

Technical Problems ◽

Technical Errors ◽

Time Flow ◽

Coronary Bypass Grafts

Background We aimed to evaluate multiple transit-time flow measurements during coronary artery bypass grafting. Methods Transit-time flow measurements were performed first on the arrested heart both with and without a proximal snare on the target coronary artery, second, after weaning from cardiopulmonary bypass, and third, before chest closure. Results Among the 214 grafts considered, 9 (4.2%) were patent and 6 (2.8%) were failing. In the failed grafts, an abnormal transit-time flow was found during the first measurement, in 5 (2.3%) cases with a proximal snare and in one (0.47%) without a snare. In these cases, technical errors with the distal anastomoses were found and immediately corrected. A problem with the proximal anastomosis was found in one graft during the second measurement and corrected right away. Bending due to excessive length was found in 2 (0.93%) grafts during the third measurement, and graft repositioning was performed. The first transit-time flow measurement showed that mean graft flow was significantly decreased with a proximal snare compared to without a proximal snare, throughout the entire coronary territory. Pulsatility index during the first transit-time flow measurement was higher with a proximal snare than without one. Conclusions The 3-time transit-time flow measurement strategy makes it possible to verify and immediately correct technical problems with coronary bypass grafts.

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