ORIGINAL ARTICLE  CARDIAC SECTION 

The Journal of Cardiovascular Surgery 2019 April;60(2):245-50

DOI: 10.23736/S0021-9509.18.10549-0

Copyright © 2018 EDIZIONI MINERVA MEDICA

language: English

Transit time flow measurement and high frequency ultrasound epicardial imaging to guide coronary artery bypass surgery

Daniel WENDT ¹, Sharaf-Eldin SHEHADA ¹ ✉, Fanar MOURAD ¹, Rene MACHULLA ¹, Ender DEMIRCIOGLU ¹, Philipp MARX ¹, Aydin DEMIRCIOGLU ², Konstantinos TSAGAKIS ¹, Matthias THIELMANN ¹, Heinz JAKOB ¹, Mohamed EL GABRY ¹

¹ Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center Essen, University Hospital Essen, Essen, Germany; ² Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany

BACKGROUND: Transit-time flow measurement (TTFM) should be routinely used in CABG surgery to verify graft function. Most recently, a 2D high-frequency-ultrasound (HF-US) epicardial imaging probe has been released (MiraQ™, Medistim, Oslo, Norway), which allows to evaluate the cannulation/clamping site of the aorta morphologically and to evaluate the completed anastomosis. We aimed to evaluate the use of TTFM and HF-US on surgical strategy during CABG surgery.
METHODS: A total of 65 consecutive patients undergoing CABG surgery were evaluated. The target vessels, the clamping/cannulation site and the anastomosis were evaluated by HF-US. TTFM was performed on all grafts and the mean flow (mL/min) and pulsatility indices (PI) were recorded. Troponin-I levels (ng/L) were obtained within the first 4 postoperative days.
RESULTS: A total of 3.3±0.9 grafts were performed, with 98.5% LIMA use and a sequential graft was performed in 55.4%. The mean PI and flow (mL/min) were 2.3±2.7 and 70.8±50.6 for the right coronary artery system, 2.4±2.2 and 82.0±47.6 for the circumflex system, and 2.1±1.2 and 78.0±35.0 for the LAD system, respectively. Postoperative troponin-I levels showed a maximum on postoperative day 1. A surgical strategy change, based on imaging, was done in 15%. Moreover, we observed a correlation of PI and flow with maximum postoperative troponin-I levels.
CONCLUSIONS: The present study evaluated the combination of TTFM and HF-US in CABG surgery. Epicardial scanning was helpful to evaluate the potential opening site of the vessel, to evaluate the completed anastomosis or to evaluate the clamping or cannulation site. Troponin-I levels were directly correlated to mean graft flow and PI levels.

KEY WORDS: Coronary artery bypass - Pulse wave analysis - Troponin I