Intraoperative Fluorescence Imaging after Transit-Time Flow Measurement during Coronary Artery Bypass Grafting

Kuroyanagi, Sachiko; Asai, Tomohiro; Suzuki, Tomoaki

doi:10.1177/155698451200700611

Cited by 6 publications

(5 citation statements)

References 14 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…90 Fluorescence coronary angiograms using indocyanine green is another imaging method for intraoperative evaluation of graft function that can potentially be coupled with TTFM, but very few data have been reported to date. 91 Finally, it must be noted that most of the published TTFM data refers to the ITA and the saphenous vein.…”

Section: Intraoperative Graft Assessment and Patencymentioning

confidence: 99%

Mechanisms, Consequences, and Prevention of Coronary Graft Failure

Gaudino¹,

Antoniades²,

Benedetto³

et al. 2017

Circulation

251

185

View full text Add to dashboard Cite

Graft failure occurs in a sizeable proportion of coronary artery bypass conduits. We herein review relevant current evidence to give an overview of the incidence, pathophysiology, and clinical consequences of this multifactorial phenomenon. Thrombosis, endothelial dysfunction, vasospasm, and oxidative stress are different mechanisms associated with graft failure. Intrinsic morphological and functional features of the bypass conduits play a role in determining failure. Similarly, characteristics of the target coronary vessel, such as the severity of stenosis, the diameter, the extent of atherosclerotic burden, and previous endovascular interventions, are important determinants of graft outcome and must be taken into consideration at the time of surgery. Technical factors, such as the method used to harvest the conduits, the vasodilatory protocol, the storage solution, and the anastomotic technique, also play a major role in determining graft success. Furthermore, systemic atherosclerotic risk factors, such as age, sex, diabetes mellitus, hypertension, and dyslipidemia, have been variably associated with graft failure. The failure of a coronary graft is not always correlated with adverse clinical events, which vary according to the type, location, and reason for failed graft. Intraoperative flow verification and secondary prevention using antiplatelet and lipid-lowering agents can help reducing the incidence of graft failure.

show abstract

Section: Intraoperative Graft Assessment and Patencymentioning

confidence: 99%

Mechanisms, Consequences, and Prevention of Coronary Graft Failure

Gaudino¹,

Antoniades²,

Benedetto³

et al. 2017

Circulation

251

185

View full text Add to dashboard Cite

show abstract

“…Previous cutoff values based on receiver operating curves have been proposed for TTFM. In terms of the parameters looked at in this study, recommended values 5,6 include a DF of greater than 50%, a PI of less than 5, and a mean flow of at least 15 mL/min. If these values were to be applied to the data in this study, two false positives would be found in terms of DF (DF G50% with patent LIMA), one false positive would be found in terms of PI (PI 95 with patent LIMA), and six false positives would be found in terms of mean flow (flow G15 with patent LIMA).…”

Section: Discussionmentioning

confidence: 99%

“…Other methods of intraoperatively evaluating the patency of grafts include intraoperative fluorescence imaging (IFI) using indocyanine green and thermal coronary angiography. 10 A recent study by Kuroyanagi et al 6 found that TTFM followed by IFI, with graft revisions performed on the basis of poor TTFM scores or delayed IFI contrast enhancement, resulted in an excellent patency rate when followed up by postoperative angiography. Although it does not provide quantifiable data, IFI may be valuable because it allows direct visualization of contrast enhancement through the graft and the distal coronary vasculature.…”

Section: Discussionmentioning

confidence: 99%

“…6 Angiograms were graded according to the Fitzgibbon criteria as Fitzgibbon A, B, or O. 8 Graft occlusion was defined as either of the following: no flow in the LIMA or flow in the LIMA to the proximal LAD but with distal LAD occlusion.…”

Section: Methodsmentioning

confidence: 99%

“…Transit time flow measurement assessment included mean flow (Q mean , in milliliters per minute), PI (PI = [Q max j Q min ]/ Q mean ), and DF (DF = Q diastole /[Q systole + Q diastole ]). 6 Angiograms were graded according to the Fitzgibbon criteria as Fitzgibbon A, B, or O. 8 Graft occlusion was defined as either of the following: no flow in the LIMA or flow in the LIMA to the proximal LAD but with distal LAD occlusion.…”

Section: Methodsmentioning

confidence: 99%

See 2 more Smart Citations

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

Walker

Daniel

Moss

et al. 2013

Innovations�(Phila)

View full text Add to dashboard Cite

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.

show abstract

Intraoperative Graft Assessment OPCAB Made in Japan

Kinoshita

Asai

2016

Off-Pump Coronary Artery Bypass

View full text Add to dashboard Cite

Intraoperative Fluorescence Imaging after Transit-Time Flow Measurement during Coronary Artery Bypass Grafting

Cited by 6 publications

References 14 publications

Mechanisms, Consequences, and Prevention of Coronary Graft Failure

Mechanisms, Consequences, and Prevention of Coronary Graft Failure

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

Intraoperative Graft Assessment OPCAB Made in Japan

Contact Info

Product

Resources

About