Ann Thorac Surg 2005;80:2161
© 2005 The Society of Thoracic Surgeons
Original article: Cardiovascular
Invited commentary
Tomislav Mihaljevic, MD
Department of Thoracic and Cardiovascular Surgery, The Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH44195
(Email: mihaljt{at}ccf.org).
The appropriate quality of coronary anastomoses and subsequent long-term graft patency remain the main technical objectives of every coronary bypass operation. The introduction of off-pump coronary artery bypass grafting has raised concerns regarding the technical quality of revascularization due to the increased difficulty of coronary artery exposure and creation of coronary anastomoses on the beating heart.
This study by Hassanein and coworkers [1] compared the quality of coronary anastomoses in patients undergoing beating heart revascularization (OPCAB) and conventional coronary revascularization. The quality of anastomoses and flow assessments were performed using the transit time flow measurements. The pulsatile index (PI) and mean flow were measured in every bypass in both groups. The main finding of the study is that OPCAB grafts to diagonal, obtuse marginal and right coronary artery territories had significantly lower PIs and flows than grafts to the same territories performed by conventional on-pump grafting. There was no significant difference in flow characteristics of grafts to the left anterior descending coronary artery territory. The OPCAB was identified as an incremental risk factor for lower flow rates and higher PIs in grafts to the obtuse marginal, diagonal, and right coronary arteries.
This article addresses an important clinical issue of intraoperative assessment of graft patency in patients undergoing coronary revascularization. Although transit time flow measurements have a number of drawbacks, they represent a useful noninvasive intraoperative method for the assessment of graft flows. The fact that average flow performances of most grafts in the OPCAB group were worse than those in patients undergoing conventional coronary artery bypass grafting represents a significant contribution to increasing knowledge about the quality of beating heart revascularization. The findings of this study echo the concern of the cardiac surgical community regarding beating heart revascularization, which has diminished initial enthusiasm for this procedure. This study has also stressed an importance of intraoperative evaluation of the quality of coronary anastomoses. We still desperately lack an accurate, noninvasive method for the real-time assessment of the coronary anatomy and patency of coronary anastomoses. Without the accurate assessment of the quality of revascularization at the end of the procedure, our ability to improve outcomes in coronary bypass surgery and to compete with the rapidly advancing field of percutaneous revascularization will remain limited.
 |
References
|
|---|
- Hassanein W, Albert AA, Arnrich B, et al. Intraoperative transit time flow measurementoff-pump versus on-pump coronary artery bypass. Ann Thorac Surg 2005;80:2155-2161.[Abstract/Free Full Text]
Top
References