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Ann Thorac Surg 1998;66:1097-1100
© 1998 The Society of Thoracic Surgeons

Supplement

Transit-time flow measurement for detection of early graft failure during myocardial revascularization

Beat H. Walpoth, MDa, Andreas Bosshard, MSa, Igor Genyk, MDa, Beat Kipfer, MDa, Pascal A. Berdat, MDa, Otto M. Hess, MDa, Ulrich Althaus, MDa, Thierry P. Carrel, MDa

a Department of Thoracic and Cardiovascular Surgery and Division of Cardiology, University Hospital, Berne, Switzerland

Address reprint requests to Dr Walpoth, Thoracic and Cardiovascular Surgery, University Hospital, Insel, CH-3010 Bern, Switzerland
e-mail: (beat.walpoth{at}insel.ch)

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

Abstract

Background. A low-flow situation in arterial and venous grafts has been associated with high rates of perioperative infarction and mortality. This study was designed to look at intraoperative graft flow and resistance in patients with coronary artery disease.

Methods. Coronary artery bypass graft flow was measured in 46 patients. Transit-time flow was used for coronary flow measurements at rest as well as after maximal vasodilation with adenosine infusion.

Results. Forty-three of the 46 patients showed normal internal mammary artery graft flow (>20 mL/min); 3 patients had no or minimal graft flow. Redoing the graft anastomosis in these 3 patients resulted in normalization of graft flow. The mean flow increased significantly after correction from 0.5 ± 0.7 mL/min to 15.7 ± 9.6 mL/min (p < 0.02). Conversely, vascular resistance decreased significantly from 138 ± 10 to 4.8 ± 1.8 Ohmv (p < 0.0001), as did the pulsatility index (from 146.9 ± 95.7 to 3.4 ± 1.8; p < 0.001). After correction, coronary flow reserve was 2.5 ± 1.1.

Conclusions. Measurements of intraoperative flow and resistance as well as derived variables allow assessment of early graft function and thus help prevent graft failure and reduce perioperative infarction. Transit-time volume flow might be a simple tool for quality control in coronary bypass procedures.




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