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Ann Thorac Surg 2008;86:823-827. doi:10.1016/j.athoracsur.2008.05.018
© 2008 The Society of Thoracic Surgeons
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Original Articles: Adult Cardiac

Effects of Intra-Aortic Balloon Pumping on Graft Flow in Coronary Surgery: An Intraoperative Transit-Time Flowmetric Study

Yoshiyuki Takami, MDa,*, Hiroshi Masumoto, MDb

a Department of Cardiovascular Surgery, Nagoya Daini Red Cross Hospital, Nagoya
b Division of Cardiovascular Surgery, Kasugai Municipal Hospital, Kasugai, Japan

Accepted for publication May 5, 2008.

* Address correspondence to Dr Takami, Department of Cardiovascular Surgery, Nagoya Daini Red Cross Hospital, 2-9 Myouken-cho, Showa-ku, Nagoya, 466-8650, Japan (Email: takami{at}nagoya2.jrc.or.jp).

Background: We investigated hemodynamic effects of intra-aortic balloon pumping (IABP) in in-situ and aorta-coronary (A-C) grafts during coronary artery bypass grafting (CABG).

Methods: One hundred seventy-two grafts, including 84 in-situ left internal thoracic arteries (LITAs), were examined intraoperatively with a transit-time flowmeter in 84 patients who had prophylactic IABP. The following measurements were obtained for each graft during off-IABP and on-IABP: mean flow, maximal flow, pulsatility index, and diastolic filling index. Coronary angiograms were performed 14 ± 5 days after coronary artery bypass graft surgery to verify the patency of the grafts.

Results: All measurements of 163 patent and measurable grafts were significantly increased with IABP: mean flow 46 ± 27 to 51 ± 29 mL/min; maximal flow 87 ± 52 to 121 ± 69 mL/min; pulsatility index 2.2 ± 1.4 to 3.1 ± 1.4; and diastolic filling index 64% ± 8% to 71% ± 9% (p < 0.001). Among them, the degrees of increase of mean flow and diastolic filling index were significantly different between the in-situ LITAs and A-C grafts (mean flow 18% ± 20% versus 10% ± 15%, p = 0.04; diastolic filling index 10% ± 8% versus 14% ± 9%, p = 0.04).

Conclusions: IABP assist significantly increases graft flow and also diastolic components of flow. The degree of increase is greater in the in-situ LITA supplying the left anterior descending artery than in A-C grafts anastomosed to other coronary arteries. IABP increases the diastolic component more in A-C grafts than in in-situ LITAs, probably because of different flow characteristics of the two grafts.


Related Article

Invited Commentary
Jan T. Christenson
Ann. Thorac. Surg. 2008 86: 827. [Extract] [Full Text] [PDF]





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