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The role of transit-time flow measurement and epicardial ultrasound in coronary artery bypass surgery: application of clinical practice
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Abstract
Introduction: Coronary artery bypass grafting remains the most commonly performed procedure for coronary artery disease. Technological and surgical innovations, including off-pump and minimally invasive surgery, have reduced risks and shortened recovery time, but demand higher technical expertise. Moreover, modern medicine also requires higher safety standards, transit-time flow measurement and epicardial ultrasound are essential techniques used for quality assesment and identifying issue during coronary artery bypass grafting surgery.
Objective: To evaluate the impact of transit-time flow measurement and epicardial ultrasound in patients undergoing coronary artery bypass grafting surgery.
Methods: A retrospective analysis of patients who underwent coronary artery bypass grafting surgery with the use of transit-time flow measurement and epicardial ultrasound. Identify the rate of changes in the selection of anastomosis sites based on epicardial ultrasound, assess graft quality using transit-time flow measurement parameters, and identify the rate of required revisions. Evaluate the rate of in-hospital mortality and major morbidity.
Results: From January 2021 to October 2024, 98 patients underwent coronary artery bypass grafting surgery with transit-time flow measurement and epicardial ultrasound at Military Hospital 175. Mean age was 61.9 years, with 24.8% female, and diabetes mellitus was 36.7%. Off-pump coronary artery bypass surgery was performed in 80.6% (n=79) of cases, minimally invasive direct coronary artery bypass in 9.2% (n=9), traditional on-pump coronary artery bypass surgery in 17.3% (n=17), and on-pump beating heart surgery in 2% (n=2).
Surgical changes were made in 33.7% of patients (n=98), with 72.7% (24 out of 33) based on findings from transit-time flow measurement and/or epicardial ultrasound. Surgical changes were related to the aorta in 10.4%, to graft vessels in 2.6%, and coronary targets in 8.3%. The rate of change in the selection of anastomosis placement based on epicardial ultrasound is 10.8% (25/230).The rate of graft revision is 0.9%. The in-hospital mortality rate was 3.1%, cerebrovascular events in 2.0%, and no new myocardial infarctions were reported.
Conclusion: Surgical changes related to the aorta, graft vessels, coronary targets, and anastomosis were performed in 33.7% of patients, contributing to low surgical mortality and severe complication rates. The combined use of transit-time flow measurement and epicardial ultrasound can enhance the quality, safety, and efficacy of coronary artery bypass grafting procedures and should be considered a standard for routine application.
Article Details
Keywords
coronary artery bypass grafting, transit-time flow measurement, epicardial ultrasound, graft patency, surgical changes
References
Copyright © 2024, StatPearls Publishing LLC.; 2024.
2. Kieser TM, Taggart DP. Current status of intra-operative graft assessment: Should it be the standard of care for coronary artery bypass graft surgery? J Card Surg. May 2018;33(5):219-228. doi:10.1111/jocs.13546
3. Trachiotis GD, Napolitano MA, Rosenfeld ES, et al. Intraoperative Graft Patency Assessment: Time to Recognize the Elephant Outside the Operating Room? Innovations (Phila). May-Jun 2021;16(3):223-226. doi:10.1177/15569845211015892
4. Neumann FJ, Sousa-Uva M, Ahlsson A, et al. 2018 ESC/EACTS Guidelines on myocardial revascularization. Eur Heart J. Jan 7 2019;40(2):87-165. doi:10.1093/eurheartj/ehy394
5. Kinoshita T, Asai T. Intraoperative Graft Assessment OPCAB Made in Japan. In: Asai T, Ochi M, Yokoyama H, eds. Off-Pump Coronary Artery Bypass. Springer Japan; 2016:137-149.
6. Gaudino M, Sandner S, Giammarco GD, et al. The Use of Intraoperative Transit Time Flow Measurement for Coronary Artery Bypass Surgery: Systematic Review of the Evidence and Expert Opinion Statements. Circulation. 2021;144(14):1160-1171. doi:doi:10.1161/CIRCULATIONAHA.121.054311
7. Quin JA, Noubani M, Rove JY, et al. Coronary Artery Bypass Grafting Transit Time Flow Measurement: Graft Patency and Clinical Outcomes. Ann Thorac Surg. Sep 2021;112(3):701-707. doi:10.1016/j.athoracsur.2020.12.011
8. Kim KB, Choi JW, Oh SJ, et al. Twenty-Year Experience With Off-Pump Coronary Artery Bypass Grafting and Early Postoperative Angiography. Ann Thorac Surg. Apr 2020;109(4):1112-1119. doi:10.1016/j.athoracsur.2019.07.053
9. Laali M, Nardone N, Demondion P, et al. Impact of transit-time flow measurement on early postoperative outcomes in total arterial coronary revascularization with internal thoracic arteries: a propensity score analysis on 910 patients. Interact Cardiovasc Thorac Surg. Jul 9 2022;35(2)doi:10.1093/icvts/ivac065
10. Balacumaraswami L, Taggart DP. Intraoperative imaging techniques to assess coronary artery bypass graft patency. Ann Thorac Surg. Jun 2007;83(6):2251-7. doi:10.1016/j.athoracsur.2006.12.025
11. Rosenfeld ES, Trachiotis GD, Sparks AD, et al. Intraoperative surgical strategy changes in patients with chronic and end-stage renal disease undergoing coronary artery bypass grafting. Eur J Cardiothorac Surg. Jun 14 2021;59(6):1210-1217. doi:10.1093/ejcts/ezab104
12. Di Giammarco G, Canosa C, Foschi M, et al. Intraoperative graft verification in coronary surgery: increased diagnostic accuracy adding high-resolution epicardial ultrasonography to transit-time flow measurement. Eur J Cardiothorac Surg. Mar 2014;45(3):e41-5. doi:10.1093/ejcts/ezt580
13. Taggart DP, Thuijs D, Di Giammarco G, et al. Intraoperative transit-time flow measurement and high-frequency ultrasound assessment in coronary artery bypass grafting. J Thorac Cardiovasc Surg. Apr 2020;159(4):1283-1292.e2. doi:10.1016/j.jtcvs.2019.05.087
14. National Institute for Health and Care Excellence. MiraQ for assessing graft flow during coronary artery bypass graft surgery. 2022. Accessed 2 November 2024. https://www.nice.org.uk/guidance/mtg8
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