Transit‐time flow measurement parameters after protamine infusion in CABG surgeries

Abstract

Objective The objective of this study is to evaluate protamine sulfate effects on graft's blood flow by comparing transit‐time flow measurement (TTFM) values before and after protamine administration. Methods This is an observational study with data collected between years 2018 and 2020. Immediate graft patency was evaluated using TTFM. Only patients with TTFM parameters registered before and after protamine infusion were included. The main three parameters studied were: mean graft flow (MGF), pulsatility index (PI), and diastolic flow (DF). In the first analysis, all conduits were evaluated regardless of the surgical technique used. In a second analysis, on‐pump and off‐pump groups were compared. Evaluated grafts were left internal thoracic artery, saphenous vein graft (SVG), radial artery, and right internal thoracic artery. Since SVG was numerically the most used graft, an exclusive analysis was created. Results Our study included 575 patients, resulting in a total of 1686 grafts, mean 2.93 grafts/patient. Off‐pump surgery was performed in 158 patients. Before protamine infusion, inadequate TTFM parameters were observed in 3.8% of grafts. Overall, after protamine administration, MGF decreased in all grafts, but its reduction was not statistically significant. PI values increased in the SVG and DF values reduced in LIMA grafts. SVG group analysis showed that after protamine PI values were higher in OM1 and RCA. DF values increased in RCA. The comparison between off and on‐pump surgeries, showed that in off‐pump cases TTFM measures did not present statistically significant differences. Conclusion Significant variations were observed in TTFM values before and after protamine administration. Although different, those values remained within the normal reference ranges. We recommend that flow measurement should be performed before protamine infusion.

Transit time flow measurement in arterial grafts

“…In a retrospective analysis of the REQUEST database [ 7 ], Leviner et al [ 24 ] showed that MGF and PI were unchanged in arterial grafts between the two measurements while there was a slight increase in MGF and slight decrease in PI in venous grafts after protamine administration. Dallan et al [ 25 ], reporting the results of TTFM measurements in 575 patients with 1686 grafts (59.6% SVG) showed no statistically significant difference in either MGF or PI in arterial grafts after protamine infusion. They also saw no difference in post protamine MGF in venous grafts but a slight increase in PI.…”