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

Walker, Patrick F.; Daniel, William T.; Moss, Emmanuel; Thourani, Vinod H.; Kilgo, Patrick D.; Liberman, Henry; Devireddy, Chandan; Guyton, Robert A.; Puskas, John D.; Halkos, Michael E.

doi:10.1097/imi.0000000000000021

Cited by 24 publications

(11 citation statements)

References 12 publications

(12 reference statements)

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“…Although intraoperative assessment of grafts with transit time flow measurement can provide physiologic assessment of bypass grafts and is currently recommended, there may be a greater incidence of false negatives compared with angiography. 2 Postoperative angiographic graft assessment is typically reserved for patients who have a deviation in expected clinical course or have objective evidence of ischemia. In postoperative CABG patients who undergo left heart catheterization for electrocardiogram changes, chest pain, or hemodynamic changes, 69% have a positive finding related to bypass grafts on imaging.…”

Section: Discussionmentioning

confidence: 99%

To intervene or not to intervene: Lessons learned from completion angiography after robotic-assisted coronary bypass surgery

Winters

Halkos

2020

JTCVS Techniques

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Disclosures: Dr Halkos is an advisory board member for Medtronic, Inc, and has a patent for a new minimally invasive coronary stabilizer. Dr Winters reported no conflicts of interest. The Journal policy requires editors and reviewers to disclose conflicts of interest and to decline handling or reviewing manuscripts for which they may have a conflict of interest. The editors and reviewers of this article have no conflicts of interest.

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Section: Discussionmentioning

confidence: 99%

To intervene or not to intervene: Lessons learned from completion angiography after robotic-assisted coronary bypass surgery

Winters

Halkos

2020

JTCVS Techniques

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“…This is angiographically seen as a 25-30% shrinking of the graft diameter. Intimal hyperplasia develops each subsequent year and 2% graft occlusion occurs per year [19,20].…”

Section: Discussionmentioning

confidence: 99%

Bilateral Semi-Skeletonized IMA; Less Thermal Injury, Easier to Harvest, Early Post Operative Comparison with Single IMA Patients After CABG

Kara¹

2018

AJCEM

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The use of BITA is prominent in coronary bypass surgery due to its positive effects on long-term mortality and morbidity. However, its use is not widespread enough among heart surgeons due to its technical difficulty and the longer period of time it requires. There are still many articles being published on the subject. In patients who receive BITA, harvesting is usually performed in a skeletonized fashion. This protects the patient from sternal complications because it disturbs the vascularity of the chest wall less compared to the pedicled technique. However, the risk for injury on IMA is high. This is where harvesting in semi-skeletonized fashion distinguishes itself. Not only does it disturb the vascularity of the chest wall less but it also has a lower risk for thermal injury. Furthermore, it provides some advantages in terms of time over skeletonized fashion. The study enrolled 24 patients who underwent an isolated CABG operation using cardiopulmonary bypass (CPB) by a single surgeon between March 2017 -December 2017. 12 patients (10 males, 2 females; mean age: 55.083) underwent CABG operation using semi-skeletonized BITA (Table 1). Another 12 patients (8 males, 4 females; mean age: 56.25) underwent CABG using LIMA and venous graft. Post-operative sternal wound complications and post-operative pain of patients were compared. In the patients of the BITA group, cross clamp time, operation time and mammary harvesting time caused a slight prolongation. None of patients had deep sternal infection or mediastinitis or mechanical sternal dehiscence. BITA harvesting patients had more postoperative pain. As a result using semi-skeletonized ITA is more beneficial for sternal wound recovery compared to IMA harvested with the pedicled technique because the former causes less trauma in the thorax and disturbs the bleeding of the chest wall less. Furthermore, we think that it has advantages in terms of time and less traumatic effects on ITA compared to ITA harvested in a skeletonized fashion.

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“…Walker et al found a significant difference in the measured graft flow between patent and nonpatent left IMA-LAD grafts. 26) Six left IMA-LAD grafts with peroperative reduced graft flow of < 15 mL/minute were found to be non-patent at follow-up by Handa et al 27) Lehnert et al found that the graft flow was directly correlated with the follow-up outcomes, with an observed 4% decreased risk of the graft failure for every 1 mL/minute increase in the graft flow. 28) These evidences were in line with the outcomes of the current study.…”

Section: Discussionmentioning

confidence: 99%

In Situ Skeletonized Right Internal Mammary Artery Bypass Grafting to Left Anterior Descending Artery

Xia²,

Shi

et al. 2018

Int. Heart J.

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SummaryThis study aimed to evaluate the feasibility and the mid-term efficacy of an in situ skeletonized right internal mammary artery (IMA) bypass grafting to a left anterior descending artery (LAD), and to determine risk factors for IMA graft failure in a single-center study.From January 2012 to December 2015, 189 patients (173 males, 50.6 ± 6.0 years old) undergoing first isolated coronary artery bypass grafting surgery with the in situ skeletonized right IMA grafting to the LAD were included in this study. Baseline characteristics, peroperative data, and follow-up outcomes were investigated and analyzed.The length of the in situ skeletonized right IMA grafts was 18.6 ± 1.2 cm (17.0-22.0 cm). Intraoperative graft flow of the in situ skeletonized right IMA grafting to LAD was 42 ± 9 mL/minute (18-72 mL/minute) associated with measured pulsatility index of 0.8-4.3. In-hospital mortality was 0.5%. Postoperative morbidity included acute myocardial infarction (0.5%), stroke (0.5%), and deep sternal wound infections (1.1%). The midterm survival was 97.2% and the incidence of repeat revascularization was 0.6%. The patency rate of the in situ skeletonized right IMA grafting to the LAD was 97.1% by computed tomography angiography examination during the follow-up period of 23.2 ± 9.7 months. Additionally, logistic regression analysis showed that intraoperative graft flow had an independent influence on the risk of the mid-term right IMA graft failure.The strategy of the in situ skeletonized right IMA grafting to the LAD is feasible and effective. Intraoperative graft flow was an independent risk factor for the mid-term right IMA graft failure.(Int Heart J 2018; 59: 35-42) Key words: Coronary artery bypass grafting, Artery skeletonization, Intraoperative graft flow, Graft patency C oronary artery bypass grafting surgery (CABG) remains one of the most common cardiac surgical procedures today. [1][2][3][4][5] It has been demonstrated to provide symptomatic relief and increase the long-term survival for patients with coronary artery disease, which is mainly attributed to a complete revascularization and a left internal mammary artery (IMA) bypass grafting to a left anterior descending artery (LAD). [1][2][3][4][5] Following the publication of the landmark study by Loop in 1986, which validated positive impacts of the IMA graft on 10-year survival and other cardiac events, the strategy of the left IMA grafting to the LAD is considered as the "gold standard" of coronary revascularization.6) Given the fact that patients who received CABG surgery often require more than one graft, the prospect of bilateral IMA grafting becomes very appealing to cardiac surgeons after recognition of the long-term benefits of left IMA graft. 7)However, the use of bilateral IMA grafting is scarcely diffused. 8,9) Concerns regarding a higher probability of deep sternal wound infections and its ensuing complications, an increased operation time, and technical challenges including utilizing and teaching the technique, have limited the widespread use...

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

Cited by 24 publications

References 12 publications

To intervene or not to intervene: Lessons learned from completion angiography after robotic-assisted coronary bypass surgery

To intervene or not to intervene: Lessons learned from completion angiography after robotic-assisted coronary bypass surgery

Bilateral Semi-Skeletonized IMA; Less Thermal Injury, Easier to Harvest, Early Post Operative Comparison with Single IMA Patients After CABG

In Situ Skeletonized Right Internal Mammary Artery Bypass Grafting to Left Anterior Descending Artery

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