Intraoperative transit time flow measurements during off‐pump coronary artery bypass surgery: The impact of coronary stenosis on competitive flow

Frank R. Halfwerk*, Pien Spoor, Silvia Mariani, Rob Hagmeijer, Jan G. Grandjean

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

Background: Combining preoperative angiography findings with intraoperative transit time flow measurements (TTFM) may improve patency of coronary artery bypass grafts. Nevertheless, graft flow might be impaired by native coronary flow based on the severity of stenoses, with inferior long-term outcomes. This study investigates the impact of left anterior descending artery (LAD) stenosis on competitive flow measured in left internal mammary artery (LIMA) grafts during off-pump coronary artery bypass grafting. Methods: Fifty patients were included in this prospective single-center cohort study. LAD stenosis was assessed with quantitative coronary analysis (QCA) and stratified into three groups based on its severity. TTFM of LIMA grafts were performed with LAD open and temporarily occluded. Change in mean graft flow after LAD snaring was the primary endpoint. Secondary endpoints included further TTFM parameters, clinical outcomes, and competitive flow index (CFI), defined as the ratio of mean graft flow with open or closed LAD. Results: Mean LAD stenosis as objectified with QCA was 58 ± 15%. Mean LIMA graft flow increased from 20 ml/min with open LAD to 30 ml/min with snared LAD (p <.001). TTFM cut-off values for graft patency improved in 26%–42% of patients after LAD occlusion. Median CFI was 0.66 (IQR: 0.56–0.82). Postoperative myocardial infarction occurred in 2.0% of patients, 120-day mortality was 0%, and 2-year mortality was 6.0%. Conclusions: Routine snaring of the LAD with CFI calculation during coronary artery bypass grafting is useful to detect significant competitive flow in LIMA grafts, potentially preventing unnecessary intraoperative graft revisions.

Original languageEnglish
Number of pages9
JournalJournal of Cardiac Surgery
Early online date21 Oct 2021
DOIs
Publication statusE-pub ahead of print/First online - 21 Oct 2021

Keywords

  • arterial grafts
  • Coronary artery bypass graft surgery
  • Coronary artery disease
  • CABG
  • Minimally invasive surgery
  • Off-pump surgery
  • UT-Hybrid-D

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