CLINICAL RESEARCH
Transit time flow measurement as a predictor of graft failure and major adverse cardiac events following coronary artery bypass grafting surgery
 
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1
Pengiran Anak Puteri Rashidah Sa’adatul Bolkiah Institute of Health Sciences, Universiti Brunei Darussalam, Brunei Darussalam
 
2
Gleneagles Jerudong Park Medical Centre, Jerudong Park, Brunei Darussalam
 
 
Submission date: 2023-08-11
 
 
Acceptance date: 2023-08-21
 
 
Publication date: 2023-09-30
 
 
Corresponding author
Kenneth Yuh Yen Kok   

Pengiran Anak Puteri Rashidah Sa’adatul Bolkiah Institute of Health Sciences, Universiti Brunei Darussalam, Tungku Link, BE1410, Bandar Seri Begawan, Brunei Darussalam
 
 
Arch Med Sci Civil Dis 2023;8(1):18-27
 
KEYWORDS
TOPICS
ABSTRACT
Introduction:
Our aims were to characterize the differences in transit time flow measurement (TTFM) between failed and normal grafts, and to determine the association between TTFM and related clinical factors and the likelihood of graft failure and major adverse cardiac events (MACE) following coronary artery bypass grafting.

Material and methods:
A retrospective observational analysis was performed on 279 patients admitted between 2017 and 2019, to compare the differences in TTFM between failed and normal grafts, and the association between TTFM and major adverse cardiac events (MACE) – specifically angina, myocardial infarction, and death.

Results:
There were no differences in TTFM between failed and normal grafts. There was a greater number of failed grafts with pulsatility index (PI) > 5 compared to PI ≤ 5 (χ2 = 4.021, p = 0.045). Multivariate analysis showed no significant association between TTFM and MACE. Increased risk of graft failure is associated with the female gender (p = 0.031), history of congestive heart failure (p = 0.025), and poor renal function (p = 0.034). Increased risk of MACE is associated with a history of coronary intervention (p = 0.041), left coronary dominance (p = 0.018), and renal function (p = 0.009).

Conclusions:
Patency of graft is influenced by gender, congestive heart failure, and renal function, while MACE is influenced by history of coronary intervention and renal function.

 
REFERENCES (30)
1.
Ohmes LB, Di Franco A, Di Giammarco G, et al. Techniques for intraoperative graft assessment in coronary artery bypass surgery. J Thorac Dis 2017; 9: S327-32.
 
2.
Head SJ, Milojevic M, Taggart DP, Puskas JD. Current practice of state-of-the-art surgical coronary revascularization. Circulation 2017; 136: 1331-45.
 
3.
Martínez-González B, Reyes-Hernández CG, Quiroga-Garza A, et al. Conduits used in coronary artery bypass grafting: a review of morphological studies. Ann Thorac Cardiovasc Surg 2017; 23: 55-65.
 
4.
Mawhinney JA, Mounsey CA, Taggart DP. The potential role of external venous supports in coronary artery bypass graft surgery. Eur J Cardiothorac Surg 2018; 53: 1127-34.
 
5.
Tan ES, Jessurun G, Deurholt W, et al. Differences between early, intermediate, and late angioplasty after coronary artery bypass grafting. Crit Pathw Cardiol 2008; 7: 239-44.
 
6.
Levine S, Mendoza CE, Virani SS, et al. Rescue percutaneous coronary intervention for graft failure immediately after coronary artery bypass grafting: case report and review of literature. J Card Surg 2008; 23: 709-12.
 
7.
Thielmann M, Massoudy P, Jaeger BR, et al. Emergency re-revascularization with percutaneous coronary intervention, reoperation, or conservative treatment in patients with acute perioperative graft failure following coronary artery bypass surgery. Eur J Cardiothorac Surg 2006; 30: 117-25.
 
8.
Tokuda Y, Song MH, Ueda Y, Usui A, Akita T. Predicting early coronary artery bypass graft failure by intraoperative transit time flow measurement. Ann Thorac Surg 2007; 84: 1928-33.
 
9.
Fleißner F, Issam I, Martens A, Cebotari S, Haverich A, Shrestha ML. The unplanned postoperative coronary angiogram after CABG: identifying the patients at risk. Thorac Cardiovasc Surg 2017; 65: 292-5.
 
10.
Preußer MJ, Landwehrt J, Mastrobuoni S, et al. Survival results of postoperative coronary angiogram for treatment of perioperative myocardial ischaemia following coronary artery bypass grafting: a single-centre experience. Interact Cardiovasc Thorac Surg 2018; 26: 237-42.
 
11.
Fitzgibbon GM, Kafka HP, Leach AJ, Keon WJ, Hooper GD, Burton JR. Coronary bypass graft fate and patient outcome: angiographic follow-up of 5,065 grafts related to survival and reoperation in 1,388 patients during. 25 years. J Am Coll Cardiol 1996; 28: 616-26.
 
12.
Taggart DP, Thuijs DJFM, Di Giammarco G, et al. Intraoperative transit-time flow measurement and high-frequency ultrasound assessment in coronary artery bypass grafting. J Thorac Cardiovasc Surg 2020; 159: 1283-92.e2.
 
13.
Kieser TM. Graft quality verification in coronary artery bypass graft surgery: how, when and why? Curr Opin Cardiol 2017; 32: 722-36.
 
14.
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: 1562-5.
 
15.
Jaber SF, Koenig SC, BhaskerRao B, Van Himbergen DJ, Spence PA. Can visual assessment of flow waveform morphology detect anastomotic error in off-pump coronary artery bypass grafting? Eur J Cardiothorac Surg 1998; 14: 476-9.
 
16.
Lamy A, Eikelboom J, Sheth T, et al. Rivaroxaban, aspirin, or both to prevent early coronary bypass graft occlusion: the COMPASS-CABG Study. J Am Coll Cardiol 2019; 73: 121-30.
 
17.
Gaudino M, Antoniades C, Benedetto U, Deb S, Di Franco A, ATLANTIC (Arterial Grafting International Consortium) Alliance et al. Mechanisms, consequences, and prevention of coronary graft failure. Circulation 2017; 136: 1749-64.
 
18.
Maddox TM, Stanislawski MA, Grunwald GK, et al. 2014 Nonobstructive coronary artery disease and risk of myocardial infarction. JAMA 2014; 312: 1754-63.
 
19.
Jannati M, Navaei MR, Ronizi LG. A comparative review of the outcomes of using arterial versus venous conduits in coronary artery bypass graft (CABG). J Family Med Prim Care 2019; 8: 2768-73.
 
20.
Caliskan E, de Souza DR, Böning A, et al. Saphenous vein grafts in contemporary coronary artery bypass graft surgery. Nat Rev Cardiol 2020; 17: 155-69.
 
21.
Karthik S, Fabri BM. Left internal mammary artery usage in coronary artery bypass grafting: a measure of quality control. Ann R Coll Surg Engl 2006; 88: 367-9.
 
22.
Tokuda Y, Song MH, Oshima H, Usui A, Ueda Y. Predicting midterm coronary artery bypass graft failure by intraoperative transit time flow measurement. Ann Thorac Surg 2008; 86: 532-6.
 
23.
Une D, Deb S, Chikazawa G, et al. Cut-off values for transit time flowmetry: are the revision criteria appropriate? J Card Surg 2013; 28: 3-7.
 
24.
Kieser TM, Rose S, Kowalewski R, Belenkie I. Transit-time flow predicts outcomes in coronary artery bypass graft patients: a series of 1000 consecutive arterial grafts. Eur J Cardiothorac Surg 2010; 38: 155-62.
 
25.
Di Giammarco G, Pano M, Cirmeni S, Pelini P, Vitolla G, Di Mauro M. Predictive value of intraoperative transit-time flow measurement for short-term graft patency in coronary surgery. J Thorac Cardiovasc Surg 2006; 132: 468-74.
 
26.
Lehnert P, Møller CH, Damgaard S, Gerds TA, Steinbrüchel DA. Transit-time flow measurement as a predictor of coronary bypass graft failure at one-year angiographic follow-up. J Card Surg 2015; 30: 47-52.
 
27.
Jokinen JJ, Werkkala K, Vainikka T, Peräkylä T, Simpanen J, Ihlberg L. Clinical value of intra-operative transit-time flow measurement for coronary artery bypass grafting: a prospective angiography-controlled study. Eur J Cardiothorac Surg 2011; 39: 918-23.
 
28.
Carey JS, Cukingnan RA, Singer LK. Health status after myocardial revascularization: inferior results in women. Ann Thorac Surg 1995; 59: 112-7.
 
29.
Abrams J. Clinical practice. Chronic stable angina. N Engl J Med 2005; 352: 2524-33.
 
30.
Khan TM, Siddiqui AH. Intra-Aortic Balloon Pump. 2022 Jun 3. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan–. https://www.ncbi.nlm.nih.gov/b... (Accessed 21 June 2023).
 
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