Abstract
Introduction. Early graft occlusion associated with worse clinical outcomes after surgery. The most common method of intraoperative graft assessment is transit-time flow measurement (TTFM). Additional intraoperative angiography (IA) performing looks promising because allows to get more anatomical information.
The aim of the study to analyze possibilities of combined TTFM and IA using and evaluate hospital outcomes Materials and methods. A retrospective study was performed. There were included 149 patients who underwent coronary artery bypass surgery in 2021-2022 years. TTFM and IA were performed in all patients. Hospital outcomes were analyzed.
Results. Mostly patients were men (79.9%), mean age was 61.9±8.2 years. They had severe angina (87.9%), half part of them had previous myocardial infarction (45.6%). Revascularization index was 3.5±0.8. Intraoperative graft assessment using TTFM allowed the identification of 21 (4.3%) suboptimal results in 19 (12.8%) patients. IA showed 6 angiographic defects, most of them (n=4) were associated with suboptimal TTFM. Based on these data 6 re-interventions were successfully performed. All patients were alive, no myocardial infarction were registered.
Conclusion. Coronary artery bypass surgery with TTFM and IA demonstrated satisfactory early clinical outcomes. Double graft control allows to detect graft dysfunction that requires re-intervention.
References
- Balacumaraswami L., Taggart D.P. Intraoperative imaging techniques to assess coronary artery bypass graft patency. Ann. Thorac. Surg. 2007; 83 (6): 2251–7. DOI: 10.1016/j.athoracsur.2006.12.025
- Yusuf S., Zucker D., Passamani E., Peduzzi P., Takaro T., Fisher L. et al. Effect of coronary artery bypass graft surgery on survival: overview of 10-year results from randomised trials by the Coronary Artery Bypass Graft Surgery Trialists Collaboration. Lancet. 1994; 344 (8922): 563–70. DOI: 10.1016/s0140-6736(94)91963-1
- Neumann F.J., Sousa-Uva M., Ahlsson A., Roffi M.. 2018 ESC/EACTS Guidelines on myocardial revascularization. Eur. Heart J. 2019; 40 (2): 87–165. DOI: 10.1093/eurheartj/ehy394
- D’Ancona G., Karamanoukian H.L., Ricci M., Schmid S., Bergsland J., Salerno T.A. Graft revision after transit time flow measurement in off-pump coronary artery bypass grafting. Eur. J. Cardiothorac. Surg. 2000; 17 (3): 287–93. DOI: 10.1016/s1010-7940(00)00332-8
- Akhrass R., Bakaeen F.G. Intraoperative graft patency validation: Friend or foe? JTCVS Techniques. 2021; 7: 131–7. DOI: 10.1016/j.xjtc.2020.12.040
- Kieser T.M., Taggart D.P. The use of intraoperative graft assessment in guiding graft revision. Ann. Cardiothorac. Surg. 2018; 7 (5): 652–62. DOI: 10.21037/acs.2018.07.06
- Enginoev S.T., Kondratiev D.A., Magomedov G.M., Kadyraliyev B.K., Chernov I.I. Intraoperative graft patency assessment using flowmetry and epicardial ultrasound in coronary artery bypass surgery. Cardiology and Cardiovascular Surgery. 2021; 14 (4): 248–52 (in Russ.). DOI: 10.17116/kardio202114041248
- Desai N.D., Miwa S., Kodama D., Koyama T., Cohen G., Pelletier M.P. et al. A randomized comparison of intraoperative indocyanine green angiography and transit-time flow measurement to detect technical errors in coronary bypass grafts. J. Thorac. Cardiovasc. Surg. 2006; 132 (3): 585–94. DOI: 10.1016/j.jtcvs.2005.09.061
- Une D., Deb S., Chikazawa G., Kommaraju K., Tsuneyoshi H., Karkhanis R. et al. Cut-off values for transit time flowmetry: Are the revision criteria appropriate? J. Cardiac. Surg. 2013. 28 (1): 3–7. DOI: 10.1111/jocs.12036
- Mukimov Sh.D., Zaikovskii V.Y., Andreev A.V., Galyautdinov D.M., Vlasova E.E., Vasiliev V.P., Shiryaev A.A. Impact of intraoperative flowmetry data on clinical and angiographic outcomes after coronary artery bypass grafting in patients with diffuse coronary atherosclerosis. Russian Cardiology Bulletin. 2021; 16 (4): 41–8 (in Russ.).
- Tolegenuly A., Ordiene R., Jakuska P., Mamedov A., Unikas R., Benetis R. Intraoperative angiography during coronary artery bypass grafting. Perfusion (United Kingdom). 2022; 37 (4): 394–401.
- Bockeria L.A., Petrosyan K.V., Bockeria O.L., Sobolev A.V., Donakanyan S.A., Golubev E.P. et al. Intraoperative bypass angiography – four-year observation experience. Ann. Surg. 2019; 24 (2): 100–7 (in Russ.). DOI: 10.24022/1560-9502-2019-24-2-100-107
- Bockeria L.A., Petrosian K.V. Intraoperative angiographic assessment of coronary artery bypass surgery results. The Bulletin of Bakoulev Center. Cardiovascular Diseases. 2019; 20 (7-8): 610–20 (in Russ.). DOI: 10.24022/1810-0694-2019-20-7-8-610-620
About the authors
- Osman A. Makhachev, Head of Reserch and Introduction of New Technologies, Chief of Chair; ORCID
- Magomedganipa N. Askadinov, Deputy Chief Physician for Surgery; ORCID
- Gadzhi M. Abusov, Cardiovascular Surgeon, Assistant of the Department; ORCID
- Karen V. Petrosyan, Dr. Med. Sci., Head of the Department; ORCID
- Rasul G. Ibragimov, Cardiovascular Surgeon; ORCID
- Osman A. Osmanov, Acting Head of Center; ORCID
- Fizuli K. Abasov, Deputy Chief Physician for Medical Work; ORCID
