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      Graft revision after transit time flow measurement in off-pump coronary artery bypass grafting.

      European Journal of Cardio-Thoracic Surgery : Official Journal of the European Association for Cardio-thoracic Surgery
      Cardiopulmonary Bypass, Coronary Artery Bypass, methods, Coronary Disease, surgery, Coronary Vessels, physiology, Diastole, Humans, Internal Mammary-Coronary Artery Anastomosis, Prospective Studies, Regional Blood Flow, Reoperation, Saphenous Vein, transplantation

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          Abstract

          To determine whether coronary graft patency can be predicted by transit time flow measurement (TTFM). From May 1 1997 to December 31 1998, TTFM was prospectively evaluated in 409 patients undergoing coronary artery bypass grafting (CABG) without cardiopulmonary bypass (CPB). All grafts (1145) were tested with TTFM. Thirty-seven out of 1145 grafts (3.2%) were revised in 33 patients (7.6%). In six cases (18.1%) use of CPB was necessary during revision due to hemodynamic instability. The remaining patients underwent revision off-pump. Thirty-four grafts (91.9%) were revised for both low flow and abnormal flow curve patterns. Findings at revision included: thrombosis of the anastomosis (n=6), stenosis at the toe or heel of the anastomosis (n=8), coronary flap or dissection (n=5), dissection of the internal mammary artery (n=5), graft kinking (n=4), flap at proximal anastomosis (n=1), coronary stenosis distal to the graft (n=3), and no findings (n=2). After revision all flow values and flow patterns improved. Although three additional grafts (8.1%) were revised for low flow (<7 ml/min) despite normal flow patterns, there were no findings at revision and flow values and curves remained unchanged after revision. Postoperatively, one patient developed a stroke (3%), one had an acute myocardial infarction (MI) (3%), one had a sternal wound infection (3%), and one required prolonged ventilatory support (3%). Evaluation of TTFM is valuable in determining the status of a coronary graft after CABG. Correct interpretation of flow patterns allows for correction of abnormalities prior to chest closure.

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