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Eur J Cardiothorac Surg 2000;17:287-293
© 2000 Elsevier Science NL
Center for Minimally Invasive Cardio-thoracic Surgery, Kaleida Health Systems and the State University of New York at Buffalo, Buffalo, NY, USA
Corresponding author. 100 High Street, Buffalo, NY 14203, USA. Tel.: +1-716-859-2248; fax: +1-716-859-2885
e-mail: nielsb{at}aol.com
Objective: To determine whether coronary graft patency can be predicted by transit time flow measurement (TTFM). Methods: From May 1 1997 to December 31 1998, TTFM was prospectively evaluated in 409 patients undergoing coronary artery bypass grafting (CABG) without cardiopulmonary bypass (CPB). All grafts (1145) were tested with TTFM. Results: Thirty-seven out of 1145 grafts (3.2%) were revised in 33 patients (7.6%). In six cases (18.1%) use of CPB was necessary during revision due to hemodynamic instability. The remaining patients underwent revision off-pump. Thirty-four grafts (91.9%) were revised for both low flow and abnormal flow curve patterns. Findings at revision included: thrombosis of the anastomosis (n=6), stenosis at the toe or heel of the anastomosis (n=8), coronary flap or dissection (n=5), dissection of the internal mammary artery (n=5), graft kinking (n=4), flap at proximal anastomosis (n=1), coronary stenosis distal to the graft (n=3), and no findings (n=2). After revision all flow values and flow patterns improved. Although three additional grafts (8.1%) were revised for low flow (<7 ml/min) despite normal flow patterns, there were no findings at revision and flow values and curves remained unchanged after revision. Postoperatively, one patient developed a stroke (3%), one had an acute myocardial infarction (MI) (3%), one had a sternal wound infection (3%), and one required prolonged ventilatory support (3%). Conclusion: Evaluation of TTFM is valuable in determining the status of a coronary graft after CABG. Correct interpretation of flow patterns allows for correction of abnormalities prior to chest closure.
Key Words: Transit time flow measurement • Off-coronary pulmonary bypass • Graft • Revision
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