Intraoperative Changes in Regional Wall Motion: Can Postoperative Coronary Artery Bypass Graft Failure Be Predicted?

ESC Joint Working Groups on Cardiovascular Surgery and the Cellular Biology of the Heart Position Paper: Peri-operative myocardial injury and infarction in patients undergoing coronary artery bypass graft surgery

“… 64 However, a large retrospective analysis found that RWMA detected by TEE were not able to predict those patients with graft failure as documented by coronary angiography. 65 One major limitation of echocardiography is that new RWMA may reflect conditions not necessarily associated with Type 5 MI and include acute ischaemia (without infarction), stunning or hibernation, and non-ischaemic conditions, such as inflammation.…”

Postcardiac surgery myocardial ischemia: Why, when, and how to intervene

“…However, in a study of more than 5000 patients, Laflamme and colleagues 13 reported that intraoperative TEE identified new RWMA in only 20% of patients ultimately diagnosed with PMI after CABG, but remained normal in 54% of patients. Likewise, in a small study of only 32 patients, De Mey and colleagues 21 found that new TEE RWMA had a specificity of only 57%.…”

“…Other analyses have reported similar findings. 7,21 Nongraft-related causes account for up to 33% of cases of PMI. This includes new native coronary artery problems (ie, plaque rupture, thrombus), distal coronary microembolism, incomplete myocardial revascularization, inadequate myocardial protection, hypercoagulability, and preoperative severe ischemic injury.…”

Complications following cardiac coronary artery bypass surgery

“…In a series of 5900 patients, 0.7% underwent early coronary angiography for early graft dysfunction. 8 Bleeding from suture lines in the aorta, and graft anastomoses and ligatures around side branches must be inspected carefully. Blocks must be taken for histological examination of the anastomosis site, the proximal and distal coronary artery and left ventricular muscle supplied by each graft.…”