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Ann Thorac Surg 1998;66:1087-1092
© 1998 The Society of Thoracic Surgeons

Supplement

Role of graft flow measurement technique in anastomotic quality assessment in minimally invasive CABG

Saad F. Jaber, MDa, Steven C. Koenig, PhDa, Bobby BhaskerRao, MDa, Daniel J. VanHimbergen, BAa, Patricia B. Cerrito, PhDa, Daniel J. Ewert, PhDa, Laman A. Gray, Jr, MDa, Paul A. Spence, MDa

a Division of Thoracic and Cardiovascular Surgery, Department of Surgery, University of Louisville, School of Medicine, Louisville, Kentucky, USA

Address reprint requests to Dr Spence, Cardiovascular Research Institute, 500 S Floyd St, Louisville, KY 40292

Presented at "Facts and Myths of Minimally Invasive Cardiac Surgery: Current Trends in Thoracic Surgery IV," New Orleans, LA, Jan 24, 1998.

Abstract

Background. Anastomotic quality is currently the critical issue in minimally invasive coronary surgery. Although little is known about its effectiveness, surgeons routinely assess grafts intraoperatively using flow probes. This study was designed to determine whether mean flow and the pattern of flow tracing in internal mammary artery grafts obtained with a transit-time flow probe are reliable indicators of anastomotic quality.

Methods. Mongrel dogs (n = 14, 30 to 35 kg) underwent off-pump left, right, or left and right internal mammary artery to left anterior descending artery anastomosis (23 grafts). Moderate to severe degrees of stenosis were created at the anastomosis by an additional suture. Internal mammary artery graft flow was measured before and after the stenosis was created with the left anterior descending artery occluded. Angiography was performed at random postoperatively to validate the degree of stenosis. Mean flow and flow tracing morphology were compared under various degrees of stenosis.

Results. There were no significant differences in mean graft flow or the morphology of the flow tracing between patent (<15%), mild (<25%), moderate (<50%), and moderately severe (<75%) stenosis. However, mean graft flow decreased (p < 0.05) with severe stenosis (>75%).

Conclusions. Although differences in mean graft flow and graft flow morphology were detectable in anastomoses with severe stenosis (>75%), they were indistinguishable in anastomoses with mild (<25%) to moderately severe (<75%) stenosis. Flow measurement techniques are valuable tools intraoperatively, but surgeons should exercise caution in their interpretation.




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