Transit-time flow predicts outcomes in coronary artery bypass graft patients: a series of 1000 consecutive arterial grafts☆

Kieser, Teresa M.; Rose, Sarah; Kowalewski, R N Marnie; Belenkie, Israel

doi:10.1016/j.ejcts.2010.01.026

Cited by 133 publications

(130 citation statements)

References 15 publications

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“…Many reports in literature demonstrated that severity of coronary artery stenosis, TTFM parameters, and severity of to and fro flow on TTFM were risk factors for further graft failure [19][20][21][22][23][24]. In the present study, we found major four types of the flow dynamics.…”

Section: The Relationship Between Hems Parameters and Cag Outcomesupporting

confidence: 57%

See 1 more Smart Citation

New Quantitative Analysis Method Using HyperEye Medical System Image for Coronary Artery Bypass Grafting

Takemi¹,

Orihashi²,

Nishimori³

et al. 2017

Angiol

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Purpose: The current evaluation by indocyanine green angiography in coronary artery bypass patients has been performed by qualitative analysis. We devised an original quantitative analysis method using Image J.Methods: Indocyanine green angiography movie was converted to spatiotemporal images. Using the spatiotemporal image, an indocyanine green fluorescence intensity curve was drawn and converted to a firstderivative (acceleration) curve. Indocyanine green angiography evaluations were classified into four types. We collected the peak indocyanine green fluorescence intensity value (peak-I) and both time interval and ratio of maximum indocyanine green acceleration value (max dI/dt) between the mid and distal portions of the graft. Results:In 61 left internal thoracic artery grafts, 49 were patent and 12 were abnormal on CAG. There were significant differences between peak-I at the mid portion of the graft (221.47 ± 39.33 vs. 184.82 ± 40.15 gray scale) and time delay with max dI/dt (0.45 ± 1.28 vs. −1.00 ± 1.25 s), but there was no significant difference in the ratio of max dI/dt between patent and abnormal grafts. Conclusions:The spatiotemporal image method may become a model of the analysis software and the time interval of max dI/dt may become a predictor for future graft failure.

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Section: The Relationship Between Hems Parameters and Cag Outcomesupporting

confidence: 57%

“…TTFM and high-frequency epicardial ultrasound have been used as popular tools in CABG [15][16][17][18][19][20][21][22][23][24]. Likewise, ICG-AG has been commonly used for evaluating graft patency.…”

Section: Discussionmentioning

confidence: 99%

New Quantitative Analysis Method Using HyperEye Medical System Image for Coronary Artery Bypass Grafting

Takemi¹,

Orihashi²,

Nishimori³

et al. 2017

Angiol

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show abstract

“…PI represents the total vascular resistance of the vessel. According to the manufacturer's documentation, a PI≥5 suggests a possibly compromised anastomosis or poor outflow bed (12,13). Mean arterial pressure (MAP) during each TTF measurement was recorded at the time of the TTF measurements and retrieved from the perfusionist's database.…”

Section: Methodsmentioning

confidence: 99%

Intra-operative Graft Blood Flow Measurements for Composite and Sequential Coronary Artery Bypass Grafting

et al. 2014

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Objectives Intraoperative assessment of coronary artery bypass grafts (CABG) anastomotic quality can be performed using transit-time flowmetry (TTF). The aim of this study was to compare on- versus off-pump coronary graft TTF and early postoperative outcomes. Materials and methods Between January 2009 and January 2010, 521 distal graft flows were assessed using TTF measurements in 253 consecutive patients undergoing primary isolated CABG surgery. Data were analyzed using multilevel models accounting for clustering among surgeons and grafts performed in the same patient. Results Mean age was 66 ± 10 years and 22% were female (n = 55) with 34% diabetics (n = 86) and 40% pre-operative myocardial infarction (MI) (n = 101). The surgeries were performed off-pump in 67% (n = 170) with sequential vein grafts in 57% (n = 144) of patients. Off-pump patients had higher pre-operative left ventricular ejection fractions (LVEF), fewer urgent surgeries, fewer distal anastomoses, and fewer sequential vein grafts (all p<0.001). Intra-operative coronary graft TTF measurements were lower in sequential vein grafts performed off-pump versus on-pump. More patients in the on-pump group needed milrinone or dobutamine 24-48 h postoperatively (p = 0.005). Independent predictors of lower TTF included female gender and off-pump surgery, whereas predictors of better TTF were pre-operative MI, larger coronary diameter at the site of the distal anastomosis, and sequential vein grafting. Conclusions Lower intra-operative TTF measurements were found in sequential vein grafts in offpump CABG. However, off-pump patients experienced similar short-term outcomes compared to on-pump patients.

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“…However, intraoperative quality assessment of the anastomosis by transit time flow measurements (TTFM) is extremely informative. TTFM is fast, non-invasive, real-time, and easy, and moreover, correct interpretation can reduce the number of technical, not visible, errors 11,12,[24][25][26] . The modern TTFM consoles automatically calculate and demonstrate real-time the mean flow, the flow curve, and the pulsatility index (PI), and lots of other parameters.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of a Novel Laser-assisted Coronary Anastomotic Connector - the Trinity Clip - in a Porcine Off-pump Bypass Model

Stecher¹,

Bronkers²,

Noest³

et al. 2014

JoVE

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To simplify and facilitate beating heart (i.e., off-pump), minimally invasive coronary artery bypass surgery, a new coronary anastomotic connector, the Trinity Clip, is developed based on the excimer laser-assisted nonocclusive anastomosis technique. The Trinity Clip connector enables simplified, sutureless, and nonocclusive connection of the graft to the coronary artery, and an excimer laser catheter laser-punches the opening of the anastomosis. Consequently, owing to the complete nonocclusive anastomosis construction, coronary conditioning (i.e., occluding or shunting) is not necessary, in contrast to the conventional anastomotic technique, hence simplifying the off-pump bypass procedure. Prior to clinical application in coronary artery bypass grafting, the safety and quality of this novel connector will be evaluated in a long-term experimental porcine off-pump coronary artery bypass (OPCAB) study. In this paper, we describe how to evaluate the coronary anastomosis in the porcine OPCAB model using various techniques to assess its quality. Representative results are summarized and visually demonstrated.

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Transit-time flow predicts outcomes in coronary artery bypass graft patients: a series of 1000 consecutive arterial grafts☆

Abstract: A high PI predicts technically inadequate arterial grafts during surgery--even if all other intra-operative assessments indicate good grafts; it also predicts outcomes, particularly mortality.

Cited by 133 publications

References 15 publications

New Quantitative Analysis Method Using HyperEye Medical System Image for Coronary Artery Bypass Grafting

New Quantitative Analysis Method Using HyperEye Medical System Image for Coronary Artery Bypass Grafting

Intra-operative Graft Blood Flow Measurements for Composite and Sequential Coronary Artery Bypass Grafting

Evaluation of a Novel Laser-assisted Coronary Anastomotic Connector - the Trinity Clip - in a Porcine Off-pump Bypass Model

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