Home > Riviste > The Journal of Cardiovascular Surgery > Fascicoli precedenti > Articles online first > The Journal of Cardiovascular Surgery 2020 Jan 23



Per abbonarsi
Sottometti un articolo
Segnala alla tua biblioteca


Publication history
Per citare questo articolo



The Journal of Cardiovascular Surgery 2020 Jan 23

DOI: 10.23736/S0021-9509.20.11150-9


lingua: Inglese

Blood flow assessment by transit time flow measurement and its prognostic impact in coronary bypass surgery

Lars NICLAUSS 1, 2 , Pier-Giorgio MASCI 3, Anna G. PAVON 3, David RODRIGUES 4, Juerg SCHWITTER 2, 3

1 Division of Cardiovascular Surgery, Cardiovascular Department, University Hospital Lausanne (CHUV), Lausanne, Switzerland; 2 Faculty of Medicine and Biology, Lausanne University, Lausanne, Switzerland; 3 Division of Cardiology and Cardiac MR Center, Cardiovascular Department, University Hospital Lausanne (CHUV), Lausanne, Switzerland; 4 Department of Radiology, University Hospital Lausanne (CHUV), Lausanne, Switzerland

BACKGROUND: The competitive coronary flow is influenced by the severity of the stenosis and may affect graft patency. Transit time flow measurement (TTFM) enables intraoperative graft evaluation and cardiac magnetic resonance (MRI) allows for graft evaluation during follow-up.
METHODS: Competitive flow and target vessel diameters were determined in 35 patients undergoing off-pump coronary bypass graft surgery (CABG) and correlated to TTFM. Cardiac function, ischemia, and graft flow were evaluated using cardiac MRI during the follow-up period to determine the impact of above-mentioned parameters on graft patency.
RESULTS: Competitive flow led to reduced mean graft flow (MGF) and increased pulsatility index (PI) in arterial grafts. This effect to was not observed in veins. Smaller target coronary arteries (<1.5 mm) were associated with reduced MGF, more pronounced in veins, which presented increased PI and shortened diastolic flow fraction (DF). No death and no re-hospitalization for acute coronary syndrome occurred. Borderline values of TTFM (mean MGF 13±4 ml/min; PI 3.8±1) in left internal mammary artery (LIMA) were mainly observed due to increased native anterior descending artery (LAD) flow. These LAD’s collateralized occluded right coronaries (RCA). The corresponding LIMA to LAD grafts showed a bypass flow increase at cardiac MRI follow-up. Two graft occlusions occurred: one in LIMA-to-LAD bypass with borderline TTFM, which did not collateralize the RCA and one in a vein graft with borderline TTFM bypassed on a narrow vascular target.
CONCLUSIONS: Competitive flow has an impact on arteries contrary to veins. Veins are at risk for occlusion when grafted to smaller targets. Borderline LIMA flow should be considered as potentially dangerous, if satisfactory explanations are missing, e.g. in the absence of a large coronary target without flow competition.

KEY WORDS: Coronary artery bypass graft surgery; Transit time flow measurement; Graft quality control; Flow measurement in coronary surgery; Cardiac magnetic resonance coronary bypass flow

inizio pagina