Intraoperative Transit Time Flow Measurement during Sequential Coronary Artery Bypass Grafting_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

YU Yang , ZHANG Fan , GAO Mingxin , LI Haitao , LI Jingxing , GU Chengxiong.

Department of Cardiac Surgery，Beijing Anzhen　Hospital，Capital Medical University，Beijing 100029，P. R. China;

Corresponding author：

Keywords：

Sequential coronary artery bypass grafting; 　Transit time flow measurement; 　Graft patency

DOI：

10.7507/1007-4848.20130166

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Objective To investigate the use of intraoperative transit time flow measurement （TTFM） to accuratelyevaluate graft patency during sequential coronary artery bypass grafting （CABG）. Methods Clinical data of 131 patientsundergoing sequential off-pump coronary artery bypass grafting （OPCAB） with the great saphenous vein （with or without internal mammary artery） as graft vessels in Beijing Anzhen Hospital from April 2012 to January 2013 were retrospectivelyanalyzed. There were 92 male and 39 female patients with their age of 61.35±8.24 years. During the operation，2 methods were used to measure mean blood flow volume，pulsatility index （PI） and diastolic filling （DF） of the graft vessels. For thenon-blocking method，blood flow in graft vessels was maintained，and TTFM was applied 2 cm proximal to the anastomoticsite in graft vessels to record above parameters. For the blocking method，blood flow in graft vessels was temporally blockedby clipping distal graft vessels with an atraumatic bulldog clamp，and TTFM was applied 2 cm proximal to the anastomotic site in graft vessels to record above parameters. Results Blood flow volumes of the diagonal branch （27.43±15.22 ml/minvs. 59.28±30.13 ml/min），obtuse marginal branch （26.14±19.74 ml/min vs. 47.19±24.27 ml/min） and posterior left ventr-icular branch （19.16±8.92 ml/min vs. 38.83±20.11 ml/min） measured by the blocking method were significantly smallerthan those measured by the non-blocking method （P＜0.05） . PI values of the diagonal branch （2.93±1.30 vs. 2.31±0.91），obtuse marginal branch （2.62±1.17 vs. 2.01±0.87） and posterior left ventricular branch （2.33±0.92 vs. 1.80±0.73） meas-ured by the blocking method were significantly higher than those measured by the non-blocking method （P＜0.05）. There was no statistical difference in DF values measured by 2 methods at respective anastomotic sites，and all DF values were higher than 50%. Non-blocking method identified 1 anastomotic site and blocking method identified 3 anastomotic sites that were not patent，and these anastomotic sites became patent after graft reconstruction. Conclusion Blood flow velocity of sequential grafts is higher than that of single grafts，indicating that sequential grafts have the advantages of high blood flow volume and low risk of thrombosis. Blocking method can more accurately evaluate graft patency at the anastomotic sites and sensitively identify graft vessels that are not patent，which is helpful for anastomotic site reconstruction in time and enhancement of successful rate of CABG.

Citation： YU Yang,ZHANG Fan,GAO Mingxin,LI Haitao,LI Jingxing,GU Chengxiong.. Intraoperative Transit Time Flow Measurement during Sequential Coronary Artery Bypass Grafting. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2013, 20(5): 524-528. doi: 10.7507/1007-4848.20130166 Copy

1.	Coronary artery surgery study （CASS）：a randomized trial of coronaryartery bypass surgery. Survival data. Circulation， 1983， 68 （5）：939-950.
2.	Magee MJ， Coombs LP， Peterson ED， et al. Patient selection and current practice strategy for off-pump coronary artery bypass surgery. Circulation， 2003， 108 （Suppl 1）：Ⅱ 9- Ⅱ 14.
3.	Emmert MY， Salzberg SP， Seifert B， et al. Routine off-pump coronaryartery bypass grafting is safe and feasible in high-risk patients with left main disease. Ann Thorac Surg， 2010， 89 （4）：1125-1130.
4.	Kappetein AP， Feldman TE， Mack MJ， et al. Comparison of coronarybypass surgery with drug-eluting stenting for the treatment of left main and/or three-vessel disease：3-year follow-up of the SYNTAX trial. Eur Heart J， 2011， 32 （17）：2125-2134.
5.	Farsak B， Tokmakoglu H， Kandemir O， et al. Angiographic assessment of sequential and individual coronary artery bypass grafting. J Card Surg， 2003， 18 （6）：524-529.
6.	Kandemir O， Tokmakoglu H， Tezcaner T， et al. Right coronary systemgrafts：alone or together with left system grafts—angiographicresults. Ann Thorac Cardiovasc Surg， 2007， 13 （1）：27-31.
7.	Beldi G， Bosshard A， Hess OM， et al. Transit time flow measurement：experimental validation and comparison of three different systems. Ann Thorac Surg， 2000， 70 （1）：212-217.
8.	Hirotani T， Kameda T， Shirota S， et al. An evaluation of the intraoperative Transit time measurements of coronary bypass flow. Eur J Cardiothorac Surg， 2001， 19 （6）：848-852.
9.	Kjaergard HK， Irmukhamedov A， Christensen JB， et al. Flow in coronary bypass conduits on-pump and off-pump. Ann Thorac Surg， 2004， 78 （6）：2054-2056.
10.	Onorati F， Pezzo F， Esposito A， et al. Single versus sequential saph-enous vein grafting of the circumflex system：a flowmetric study. Scand Cardiovasc J， 2007， 41 （4）：265-271.
11.	Walpoth BH， Bosshard A， Genyk I， et al. Transit-time flow measurement for detection of early graft failure during myocardial revascularization. Ann Thorac Surg， 1998， 66 （3）：1097-1100.
12.	Di Giammarco G， Pano M， Cirmeni S， et al. Predictive value ofintraoperative transit-time flow measurement for short-term graft patencyin coronary surgery. J Thorac Cardiovasc Surg， 2006， 132 （3）：468-474.
13.	宋跃，张健群，党海明，等. 术中即时桥血管流量测定在不停跳冠状动脉旁路移植术中的应用研究. 心肺血管病杂志， 2012， 31 （1）：18-20.
14.	D′Ancona G， Karamanoukian HL， Ricci M， et al. Graft patency verification in coronary artery bypass grafting：Principles and clinical applications of transit time flow measurement. Angiology， 2000， 51 （9）：725-731.
15.	Yu Y， Yan XL， Wei H， et al. Off-pump sequential bilateral internal mammary artery grafting combined with selective arterialization of the coronary venous system. Chin Med J （Engl）， 2011， 124 （19）：3017-3021.
16.	D′Ancona G， Karamanoukian HL， Ricci M， et al. Graft revision after Transit time flow measurement in off-pump coronary arterybypass grafting. Eur J Cardiothorac Surg， 2000， 17 （3）：287-293.
17.	Nordgaard H， Vitale N， Haaverstad R. Transit-time blood flow measurements in sequential saphenous coronary artery bypass grafts. Ann Thorac Surg， 2009， 87 （5）：1409-1415.
18.	王睿，陈鑫，石开虎，等. 体外与非体外循环冠状动脉旁路移植术治疗高危冠心病患者的对比分析. 中国胸心血管外科临床杂志， 2008， 15 （2）：143-144.
19.	刘军锋，王雪艳，贾克刚，等. 冠状动脉旁路移植术后血栓形成和再狭窄影响因素的研究现状. 中华老年心脑血管病杂志， 2012， 14 （6）：660-662.
20.	Tokuda Y， Song MH， Oshima H， et al. Predicting midterm coronaryartery bypass graft failure by intraoperative Transit time flow measurement. Ann Thorac Surg， 2008， 86 （2）：532-536.
21.	Kim HJ， Lee TY， Kim JB et al. The impact of sequential versus single anastomoses on flow characteristics and mid-term patency of saphenous vein grafts in coronary bypass grafting. J Thorac CardiovascSurg， 2011， 141 （3）：750-754.
22.	Yu Y ， Qi DN， Gu CX. Sequential saphenous vein grafting combinedwith selective arterialization of middle cardiac vein during off-pump coronary artery bypass surgery. Chin Med J （Engl）， 2010， 123 （19）：2739-2740.
23.	Derek KHL， Venkataraman A， Arulkumaran N， et al. Transit-time flow measurement is essential in coronary artery bypass grafting. Ann Thorac Surg， 2005， 79 （3）：854-858.
24.	王明岩，高长青，王刚，等. 非体外循环冠状动脉旁路移植术后大隐静脉序贯桥与单支桥中期通畅率的比较. 中国胸心血管外科临床杂志， 2011， 18 （5）：399-403.
25.	董士勇，李一帆，宋波，等. 非体外循环冠状动脉旁路移植术围手术期心肌梗死发生率与移植血管血流量的关系. 中国胸心血管外科临床杂志， 2011， 18 （6）：498-502.

1. 　Coronary artery surgery study （CASS）：a randomized trial of coronaryartery bypass surgery. Survival data. Circulation， 1983， 68 （5）：939-950.
2. 　Magee MJ， Coombs LP， Peterson ED， et al. Patient selection and current practice strategy for off-pump coronary artery bypass surgery. Circulation， 2003， 108 （Suppl 1）：Ⅱ 9- Ⅱ 14.
3. 　Emmert MY， Salzberg SP， Seifert B， et al. Routine off-pump coronaryartery bypass grafting is safe and feasible in high-risk patients with left main disease. Ann Thorac Surg， 2010， 89 （4）：1125-1130.
4. 　Kappetein AP， Feldman TE， Mack MJ， et al. Comparison of coronarybypass surgery with drug-eluting stenting for the treatment of left main and/or three-vessel disease：3-year follow-up of the SYNTAX trial. Eur Heart J， 2011， 32 （17）：2125-2134.
5. 　Farsak B， Tokmakoglu H， Kandemir O， et al. Angiographic assessment of sequential and individual coronary artery bypass grafting. J Card Surg， 2003， 18 （6）：524-529.
6. 　Kandemir O， Tokmakoglu H， Tezcaner T， et al. Right coronary systemgrafts：alone or together with left system grafts—angiographicresults. Ann Thorac Cardiovasc Surg， 2007， 13 （1）：27-31.
7. 　Beldi G， Bosshard A， Hess OM， et al. Transit time flow measurement：experimental validation and comparison of three different systems. Ann Thorac Surg， 2000， 70 （1）：212-217.
8. 　Hirotani T， Kameda T， Shirota S， et al. An evaluation of the intraoperative Transit time measurements of coronary bypass flow. Eur J Cardiothorac Surg， 2001， 19 （6）：848-852.
9. 　Kjaergard HK， Irmukhamedov A， Christensen JB， et al. Flow in coronary bypass conduits on-pump and off-pump. Ann Thorac Surg， 2004， 78 （6）：2054-2056.
10. 　Onorati F， Pezzo F， Esposito A， et al. Single versus sequential saph-enous vein grafting of the circumflex system：a flowmetric study. Scand Cardiovasc J， 2007， 41 （4）：265-271.
11. 　Walpoth BH， Bosshard A， Genyk I， et al. Transit-time flow measurement for detection of early graft failure during myocardial revascularization. Ann Thorac Surg， 1998， 66 （3）：1097-1100.
12. 　Di Giammarco G， Pano M， Cirmeni S， et al. Predictive value ofintraoperative transit-time flow measurement for short-term graft patencyin coronary surgery. J Thorac Cardiovasc Surg， 2006， 132 （3）：468-474.
13. 　宋跃，张健群，党海明，等. 术中即时桥血管流量测定在不停跳冠状动脉旁路移植术中的应用研究. 心肺血管病杂志， 2012， 31 （1）：18-20.
14. 　D′Ancona G， Karamanoukian HL， Ricci M， et al. Graft patency verification in coronary artery bypass grafting：Principles and clinical applications of transit time flow measurement. Angiology， 2000， 51 （9）：725-731.
15. 　Yu Y， Yan XL， Wei H， et al. Off-pump sequential bilateral internal mammary artery grafting combined with selective arterialization of the coronary venous system. Chin Med J （Engl）， 2011， 124 （19）：3017-3021.
16. 　D′Ancona G， Karamanoukian HL， Ricci M， et al. Graft revision after Transit time flow measurement in off-pump coronary arterybypass grafting. Eur J Cardiothorac Surg， 2000， 17 （3）：287-293.
17. 　Nordgaard H， Vitale N， Haaverstad R. Transit-time blood flow measurements in sequential saphenous coronary artery bypass grafts. Ann Thorac Surg， 2009， 87 （5）：1409-1415.
18. 　王睿，陈鑫，石开虎，等. 体外与非体外循环冠状动脉旁路移植术治疗高危冠心病患者的对比分析. 中国胸心血管外科临床杂志， 2008， 15 （2）：143-144.
19. 　刘军锋，王雪艳，贾克刚，等. 冠状动脉旁路移植术后血栓形成和再狭窄影响因素的研究现状. 中华老年心脑血管病杂志， 2012， 14 （6）：660-662.
20. 　Tokuda Y， Song MH， Oshima H， et al. Predicting midterm coronaryartery bypass graft failure by intraoperative Transit time flow measurement. Ann Thorac Surg， 2008， 86 （2）：532-536.
21. 　Kim HJ， Lee TY， Kim JB et al. The impact of sequential versus single anastomoses on flow characteristics and mid-term patency of saphenous vein grafts in coronary bypass grafting. J Thorac CardiovascSurg， 2011， 141 （3）：750-754.
22. 　Yu Y ， Qi DN， Gu CX. Sequential saphenous vein grafting combinedwith selective arterialization of middle cardiac vein during off-pump coronary artery bypass surgery. Chin Med J （Engl）， 2010， 123 （19）：2739-2740.
23. 　Derek KHL， Venkataraman A， Arulkumaran N， et al. Transit-time flow measurement is essential in coronary artery bypass grafting. Ann Thorac Surg， 2005， 79 （3）：854-858.
24. 　王明岩，高长青，王刚，等. 非体外循环冠状动脉旁路移植术后大隐静脉序贯桥与单支桥中期通畅率的比较. 中国胸心血管外科临床杂志， 2011， 18 （5）：399-403.
25. 　董士勇，李一帆，宋波，等. 非体外循环冠状动脉旁路移植术围手术期心肌梗死发生率与移植血管血流量的关系. 中国胸心血管外科临床杂志， 2011， 18 （6）：498-502.

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Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Intraoperative Transit Time Flow Measurement during Sequential Coronary Artery Bypass Grafting

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