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Ann Thorac Surg 2000;69:1300-1301
© 2000 The Society of Thoracic Surgeons

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CORRESPONDENCE

Flow measurement in coronary artery surgery

^a Center for Minimally Invasive Cardiothoracic Surgery, Kaleida Health Systems, State University of New York at Buffalo, Buffalo, NY, USA 14203

e-mail: neilsb{at}aol.com

To the Editor

We read with interest the article by Louagie and colleagues [1] and congratulate them for the scientific value of their publication. In 1996 we started using intraoperative graft flow measurements in off-pump coronary artery bypass grafting. A recent analysis of our data included 1,145 grafts tested intraoperatively with transit time flow measurement (TTFM) [2]. Thirty-seven grafts were revised due to abnormal TTFM findings (abnormal systolic curve, low flow, and high pulsatile index [PI]). On surgical revision, 34 grafts were found to be stenotic; revision of the remaining 3 grafts was performed on the basis of low mean flow values (5 mL/min) despite normal flow curves and PI. There were no abnormal findings at revision of those grafts, and PI and flow values remained unchanged after reconstructing the anastomoses.

We agree with Louagie and colleagues that mean flow values are not independently related to graft patency, but we strongly believe that PI values are strictly correlated to the quality of the anastomoses, as demonstrated by our clinical experience.

Regarding the predictive value of intraoperative graft hemodynamic assessment for midterm angiographic stenoses, we believe that flow measurements should always be performed by snaring proximally the coronary artery to exclude competitive flow and detect stenoses at the toe of the anastomoses. Flow and PI values recorded without snaring the coronary artery are not, in our opinion, good indicators of the quality of the anastomosis and, therefore, cannot be predictors of stenoses at midterm angiographic studies.

Postoperative outcome can be improved by meticulous use and understanding of TTFM in patients undergoing coronary artery surgical procedures. Graft revision should be performed promptly whenever mean flows and PI values are abnormal. Only proper use of TTFM and correct interpretation of hemodynamic values can predict midterm angiographic results.

References

1. Louagie Y., Brockmann C., Jamart J., et al. Pulsed Doppler intraoperative flow assessment and midterm coronary graft patency. Ann Thorac Surg 1998;66:1282-1288.[Abstract/Free Full Text]
2. D’Ancona G, Karamanoukian H, Salerno T, Schmid S, Bergsland J. Graft revision after transit time flow measurement in off-pump coronary artery bypass grafting. Presented at the European Association of Cardiothoracic Surgery, Glasgow, Scotland, September 1999.

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Hratch L. Karamanoukian Tomas A. Salerno Marco Ricci Jacob Bergsland Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by D’Ancona, G. Articles by Bergsland, J. Search for Related Content PubMed Articles by D’Ancona, G. Articles by Bergsland, J.