Abstract
ObjectiveThis retrospective study sought to evaluate the efficacy of transit time flow measurement (TTFM) as a means of predicting bypass graft patency as assessed by coronary artery angiography upon 5-year follow-up.MethodsOf 311 patients undergone isolated off-pump coronary artery bypass graft surgery from January 2014 through December 2014, 202 (65%) underwent both intraoperative TTFM and angiography at follow-up. 610 grafts, 202 left internal mammary artery grafts and 408 saphenous vein grafts were checked. Any grafts that exhibited Fitzgibbon type B or O lesions upon angiographic evaluation were considered to be failing. Receiver operating characteristic curves were used to identify the optimal TTFM values for predicting graft patency.ResultsA total of 610 grafts were included in this analysis, including 202 LIMA grafts and 408 SV grafts, of which 107, 129, 129, and 43 anastomosed to DIAG, OM, PDA, and PLA, respectively. LIMA, DIAG, OM, PDA, and PLA bypass grafts had overall patency rates of 95.0%, 74.8%, 73.6%, 71.5%, and 74.4%, respectively, upon 5-year follow up. No significant differences in TTFM values (MGF, PI, and DF) were observed when comparing outcomes associated with individual or sequential SV grafting. MGF was found to be predictive of graft failure regardless of the target vessel (P < 0.05). While PI was found to predict LIMA, OM, and PDA graft failure (P < 0.05), it was not associated with the failure of grafts associated with DIAG and PLA vessels. Similarly, DF was found to predict OM and PDA graft failure (P < 0.05), but was not significantly associated with the failure of grafts associated with LIMA, DIAG, or PLA vessels.ConclusionLIMA bypass grafts were associated with better 5-year graft patency relative to SV bypass grafts. Similar graft patency rates were observed for both individual and sequential bypass grafts. MGF was able to predict bypass graft failure in patients that underwent off-pump CABG surgery.
Highlights
Coronary artery bypass graft (CABG) surgery outcomes have significantly improved over the last 50 years [1], with this treatment remaining the optimal treatment for those with complex multivessel disease [2]
Graft distributions In total, 610 total grafts (3.01 grafts/patient) were included in the present study, including 202 Left internal mammary artery (LIMA) grafts anastomosed to the Left anterior descending artery (LAD), and 408 saphenous vein (SV) grafts that were anastomosed to Diagonal artery (DIAG), Obtuse marginal branch of circumflex artery (OM), Posterior descending artery (PDA), and PLA in 107, 129, 129, and 43 cases, respectively
transit time flow measurement (TTFM) parameters No significant differences in TTFM parameters (MGF, Pulsatile index (PI), and Diastolic filtration (DF)) were observed when comparing individual and sequential SV grafting (Table 2), enabling us to analyze SV grafts in different distributions without taking grafting technique into consideration during these analyses
Summary
Coronary artery bypass graft (CABG) surgery outcomes have significantly improved over the last 50 years [1], with this treatment remaining the optimal treatment for those with complex multivessel disease [2]. Zeng et al Journal of Cardiothoracic Surgery (2021) 16:334 coronary artery angiography (CAG) is the gold-standard approach used to assess graft patency, it can be an inconvenient and invasive procedure when conducted intraoperatively. Few published studies to date, have evaluated the reliability of TTFM as a means of predicting longterm CAG graft patency findings in patients undergoing off-pump CABG surgery. This study was designed to assess the ability of TTFM parameters to predict 5-year postoperative graft patency outcomes in off-pump CABG patients
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