Influence of Transit Time Flow Measurements on Short-term Prognosis after Off-pump Coronary Artery Bypass Grafting_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

SUNWen-qiang , LIUXi , TANGYin , LIUJing , QINJun-chao , BAOLi-ming , YANGWei , LIANBo ,  CHENYu

Department of Cardiac Surgery, Heart Center, People's Hospital of Peking University, Beijing 100044, P. R. China;

Corresponding author：

CHENYu, Email: chenyu@pkuph.edu.cn

Keywords：

Off-pump coronary artery bypass grafting; Graft flow; Pulsatility index; Perioperative myocardial infarction

DOI：

10.7507/1007-4848.20150210

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

Objective To investigate predictive value of intraoperative graft flow measurements during off-pump coronary artery bypass grafting (OPCAB) for early clinical prognosis. Methods We retrospectively analyzed the clinical data of 133 patients with three-vessel disease who underwent OPCAB in the Department of Cardiac Surgery of People's Hospital of Peking University in 2013 year. There were 103 males and 30 females with mean age of 62.84±7.13 years. Pulsatility index (PI) and mean flow were measured using a flow metre before the end of surgery. Then the total graft flow and the average graft flow were calculated. Univariate, bivariate correlation and logistic regression analysis were performed for statistical analysis. Results The blood flow and PI of LIMA-to-LAD graft was respectively 28.69±16.90 ml/min and 2.70±1.39, and the total graft flow and the average graft flow was respectively 79.94±37.20 ml/min and 35.55±16.75 ml/min. The PI of LIMA-to-LAD graft was significantly correlated with serum cardiac troponin I(cTnI)level in 12 hours, with the highest serum cTnI level within 48 hours, with ICU stay and with ventilator time (P<0.01), but the correlation was not strong(coefficient correlation <0.4). Compared with the patients without perioperative myocardial infarction (PMI), the blood flow of LIMA-to-LAD graft, the total graft flow and the average graft flow were lower in the patients with PMI (P<0.01). Logistic regression analysis revealed that the total graft flow was an independent predictor of PMI (P=0.004, RR=0.950, 95%CI 0.918-0.984). Conclusion Intraoperative graft flow measurements during OPCAB can predict shortterm prognosis. The lower total graft flow is a risk factor for PMI.

Citation： SUNWen-qiang, LIUXi, TANGYin, LIUJing, QINJun-chao, BAOLi-ming, YANGWei, LIANBo, CHENYu. Influence of Transit Time Flow Measurements on Short-term Prognosis after Off-pump Coronary Artery Bypass Grafting. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2015, 22(9): 841-845. doi: 10.7507/1007-4848.20150210 Copy

1.	Leong DK, Ashok V, Nishkantha A, et al. Transit-time flow measurement is essential in coronary artery bypass grafting. Ann Thorac Surg, 2005, 79(3):854-857.
2.	Kim KB, Kim JS, Kang HJ, et al. Ten-year experience with offpump coronary artery bypass grafting:lessons learned from early postoperative angiography. J Thorac Cardiovasc Surg, 2010, 139(2):256-262.
3.	Jelenc M, Jelenc B, Klokočovnik T, et al. Understanding coronary artery bypass transit time flow curves:role of bypass graft compliance. Interact Cardiovasc Thorac Surg, 2014,18(2):164-168.
4.	Succi JE, Gerola LR, Succi Gde M, et al. Intraoperative coronary grafts flow measurement using the TTFM flowmeter:results from a domestic sample. Rev Bras Cir Cardiovasc, 2012, 27(3):401-404.
5.	Shin H, Yozu R, Mitsumaru A, et al. Intraoperative assessment of coronary artery bypass graft:transit-time flowmetry versus angiography. Ann Thorac Surg, 2001, 72(5):1562-1565.
6.	Herman C, Sullivan JA, Buth K, et al. Intraoperative graft flow measurements during coronary artery bypass surgery predict in-hospital outcomes. Interact Cardiovasc Thorac Surg, 2008, 7(4):582-585.
7.	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.
8.	Walker PF, Daniel WT, Moss E, et al. The accuracy of transit time flow measurement in predicting graft patency after coronary artery bypass grafting. Innovations(Phila), 2013, 8(6):416-419.
9.	Jokinen JJ, Werkkala K, Vainikka T, et al. Clinical value of intraoperative transit-time flow measurement for coronary artery bypass grafting:a prospective angiography-controlled study. Eur J Cardiothorac Surg, 2011, 39(6):918-923.
10.	Thygesen K, Alpert JS, Jaffe AS, et al. Third universal definition of myocardial infarction. J Am Coll Cardiol, 2012, 60(16):1581-1598.
11.	Head SJ, Holmes DR Jr, Mack MJ, et al. Risk profile and 3-year outcomes from the SYNTAX percutaneous coronary intervention and coronary artery bypass grafting nested registries. JACC Cardiovasc Interv, 2012, 5(6):618-625.
12.	Balacumaraswami L, Taggart DP. Digital tools to facilitate intraoperative coronary artery bypass graft patency assessment. Semin Thorac Cardiovasc Surg, 2004, 16(3):266-271.
13.	Leong DK, Ashok V, Ishkantha A, et al. Transit-time flow measurement is essential in coronary artery bypass grafting. Ann Thorac Surg, 2005, 79(3):854-857.
14.	Di Giammarco G, Pano M, Cirmeni S, et al. Predictive value of intraoperative transit-time flow measurement for short-term graft patency in coronary surgery. J Thorac Cardiovasc Surg, 2006, 132(3):468-474.
15.	高长青, 张涛, 李伯君, 等. 中国人移植的乳内动脉平均流量测定及影响因素. 中国胸心血管外科临床杂志, 2004, 11(2):84-87.
16.	潘世伟, 胡盛寿, 许建屏, 等. 非体外循环和体外循环冠状动脉旁路移植术桥流量变化的对比分析. 中国循环杂志, 2007, 22(6):459-462.
17.	Mair J, Larue C, Mair P, et al. Use of cardiac troponin I to diagnose perioperative myocardial infarction in coronary artery bypass grafting. Clin Chem, 1994, 40(11 Pt 1):2066-2070.
18.	高长青, 肖苍松, 李伯君, 等. 国人桥血流搏动指数的研究. 中华胸心血管外科杂志, 2004, 20(1):33-35.
19.	Tokuda Y, Song MH, Oshima H, et al. Predicting midterm coronary artery bypass graft failure by intraoperative transit time flow measurement. Ann Thorac Surg, 2008, 86(2):532-536.
20.	Kieser TM, Rose S, Kowalewski R, et al. Transit-time flow predicts outcomes in coronary artery bypass graft patients:a series of 1000 consecutive arterial grafts. Eur J Cardiothorac Surg, 2010, 38(2):155-162.

1. Leong DK, Ashok V, Nishkantha A, et al. Transit-time flow measurement is essential in coronary artery bypass grafting. Ann Thorac Surg, 2005, 79(3):854-857.
2. Kim KB, Kim JS, Kang HJ, et al. Ten-year experience with offpump coronary artery bypass grafting:lessons learned from early postoperative angiography. J Thorac Cardiovasc Surg, 2010, 139(2):256-262.
3. Jelenc M, Jelenc B, Klokočovnik T, et al. Understanding coronary artery bypass transit time flow curves:role of bypass graft compliance. Interact Cardiovasc Thorac Surg, 2014,18(2):164-168.
4. Succi JE, Gerola LR, Succi Gde M, et al. Intraoperative coronary grafts flow measurement using the TTFM flowmeter:results from a domestic sample. Rev Bras Cir Cardiovasc, 2012, 27(3):401-404.
5. Shin H, Yozu R, Mitsumaru A, et al. Intraoperative assessment of coronary artery bypass graft:transit-time flowmetry versus angiography. Ann Thorac Surg, 2001, 72(5):1562-1565.
6. Herman C, Sullivan JA, Buth K, et al. Intraoperative graft flow measurements during coronary artery bypass surgery predict in-hospital outcomes. Interact Cardiovasc Thorac Surg, 2008, 7(4):582-585.
7. 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.
8. Walker PF, Daniel WT, Moss E, et al. The accuracy of transit time flow measurement in predicting graft patency after coronary artery bypass grafting. Innovations(Phila), 2013, 8(6):416-419.
9. Jokinen JJ, Werkkala K, Vainikka T, et al. Clinical value of intraoperative transit-time flow measurement for coronary artery bypass grafting:a prospective angiography-controlled study. Eur J Cardiothorac Surg, 2011, 39(6):918-923.
10. Thygesen K, Alpert JS, Jaffe AS, et al. Third universal definition of myocardial infarction. J Am Coll Cardiol, 2012, 60(16):1581-1598.
11. Head SJ, Holmes DR Jr, Mack MJ, et al. Risk profile and 3-year outcomes from the SYNTAX percutaneous coronary intervention and coronary artery bypass grafting nested registries. JACC Cardiovasc Interv, 2012, 5(6):618-625.
12. Balacumaraswami L, Taggart DP. Digital tools to facilitate intraoperative coronary artery bypass graft patency assessment. Semin Thorac Cardiovasc Surg, 2004, 16(3):266-271.
13. Leong DK, Ashok V, Ishkantha A, et al. Transit-time flow measurement is essential in coronary artery bypass grafting. Ann Thorac Surg, 2005, 79(3):854-857.
14. Di Giammarco G, Pano M, Cirmeni S, et al. Predictive value of intraoperative transit-time flow measurement for short-term graft patency in coronary surgery. J Thorac Cardiovasc Surg, 2006, 132(3):468-474.
15. 高长青, 张涛, 李伯君, 等. 中国人移植的乳内动脉平均流量测定及影响因素. 中国胸心血管外科临床杂志, 2004, 11(2):84-87.
16. 潘世伟, 胡盛寿, 许建屏, 等. 非体外循环和体外循环冠状动脉旁路移植术桥流量变化的对比分析. 中国循环杂志, 2007, 22(6):459-462.
17. Mair J, Larue C, Mair P, et al. Use of cardiac troponin I to diagnose perioperative myocardial infarction in coronary artery bypass grafting. Clin Chem, 1994, 40(11 Pt 1):2066-2070.
18. 高长青, 肖苍松, 李伯君, 等. 国人桥血流搏动指数的研究. 中华胸心血管外科杂志, 2004, 20(1):33-35.
19. Tokuda Y, Song MH, Oshima H, et al. Predicting midterm coronary artery bypass graft failure by intraoperative transit time flow measurement. Ann Thorac Surg, 2008, 86(2):532-536.
20. Kieser TM, Rose S, Kowalewski R, et al. Transit-time flow predicts outcomes in coronary artery bypass graft patients:a series of 1000 consecutive arterial grafts. Eur J Cardiothorac Surg, 2010, 38(2):155-162.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Influence of Transit Time Flow Measurements on Short-term Prognosis after Off-pump Coronary Artery Bypass Grafting

Abstract Full text Figures/Tables Video References Cited by

Previous Article

Next Article

Format

Content