Assessment of Left Mammary Artery Grafts (LIMA) to Left Anterior Descending Artery (LAD) after Off-Pump Coronary Artery Bypass Grafting by Color Doppler

Abstract

Background: Off-pump coronary artery bypass grafting (OPCAB) on a beating heart with a LIMA graft to the LAD is established for patients with one vessel disease. The aim of the study was to assess the LIMA patency noninvasive by transcutaneous duplex ultrasound. Methods: 25 patients (16 male, 9 female, mean age 58±13 yr) with LIMA grafts to LAD by OPCAB procedures were studied 7–20 days after surgery. Doppler velocity parameters were measured by use of a 7 MHz transducer placed in left intercostal space. The conventional coronary angiographies performed showed the LIMA graft patent. Results: In all cases a typical biphasic pattern of blood flow was recorded with forward flow in both systole and diastole respectively. Under basal conditions the mean peak velocities in systole were 0.36 m/s and the mean peak velocities in diastole were 0.27 m/s with a mean systolic/diastolic ratio of 1.33. Conclusion: Transcutaneous Doppler ultrasound is useful in the detection of the LIMA graft flow. This non-invasive technique may find applications for routine postoperative follow-up of patients with LIMA grafts.

Assessment of the Graft Quality and Patency during and after Coronary Artery Bypass Grafting

“…Since the 1990s, flow in the LIMA has been investigated using TDE [86,87]. Several studies have reported the usefulness of TDE for the LITA-LAD graft assessment [88][89][90][91][92][93]. A study by Hirata et al examined 35 patients who underwent CABG using LITA-LAD grafting followed by a postoperative coronary angiographic examination [87].…”

“…In conclusion, they mentioned that noninvasive TDE compared favorably with coronary angiography and was considered to be reliable and able to provide greater information regarding the physiologic state in the area of anastomosis [87]. Additionally, a study by Driever et al concluded that transcutaneous Doppler ultrasound was useful in the detection of LIMA graft flow and hence the results favored the routine use of this non-invasive technique in postoperative follow-up of patients with LIMA grafts [91]. Similarly, Van Son et al concluded that Doppler spectrum analysis may be used in the postoperative serial assessment of IMA graft function [92].…”