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Tetsuro Morota
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William R. Burfeind
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Ann Thorac Surg 2002;73:1446-1450
© 2002 The Society of Thoracic Surgeons

Original article: cardiovascular

Intraoperative evaluation of coronary anastomosis by transit-time ultrasonic flow measurement

Tetsuro Morota, MD, PhD*a, Francis G. Duhaylongsod, MDa, William R. Burfeind, MDa, Ching-Tsorng Huang, MDa

a Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA

Accepted for publication February 5, 2002.

* Address reprint requests to Dr Morota, Department of Cardiothoracic Surgery, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
e-mail: morotat-sur{at}h.u-tokyo.ac.jp

Background. Intraoperative assessment of the anastomosis is important during coronary bypass on a beating heart. The purpose of this study is to predict the quality of anastomosis using transit-time flow measurement and to find out the most accurate indicator.

Methods. Eight swine underwent internal thoracic-anterior descending coronary artery bypass grafting on a beating heart. Flow measurement and angiography were performed at various degrees of stenosis created on the graft. As flow parameters, total flow, systolic flow, diastolic flow, diastolic/total flow ratio, systolic peak flow, diastolic peak flow, systolic/diastolic peak flow index, and pulsatility index were used. Mixed procedure and probability test (negative means successful anastomosis) were used to analyze the diagnostic ability.

Results. Diastolic flow, diastolic/total flow ratio, diastolic peak flow, systolic/diastolic peak flow index, and pulsatility index showed significant variance with increased stenosis. Among these measures, diastolic/total flow ratio showed the highest value of area under the curve (0.91) and the highest specificity (82%) at 90% sensitivity with actual value of 42%.

Conclusions. Diastolic/total flow ratio was the most reliable indicator to predict critical stenosis in coronary artery bypass grafting.




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