Optimized technique for intraoperative graft verification by ultrasonic flowmetry during coronary artery bypass surgery
https://doi.org/10.29001/2073-8552-2021-36-1-92-100
Abstract
Purpose. To determine the role of three-stage ultrasonic flowmetry of coronary bypass grafts for the purpose of early verification of technical errors during coronary bypass surgery.
Material and Methods. A total of 214 grafts were analyzed. The first stage of flowmetry was performed on the arrested heart with and without proximal loop test; the second stage was performed after weaning patient from the heart-lung machine; the third was done after inactivation of heparin until the closure of the chest wound.
Results. Among 214 grafts, flowmetry revealed insufficient blood flow in 4.2% (n = 9) of cases. Technical surgical errors in these shunts were confirmed during their revision. During the first measurement, non-optimal flowmetry parameters were observed in six cases (2.8%) including five cases (2.3%) where non-optimal blood flow was verified using a proximal loop test on the target coronary artery and one case (0.47%), which was not tested. Inadequate blood flow was found in one case (0.47%) during the second measurement, which confirmed technical errors in the proximal anastomoses. Low blood flow parameters were found in two cases (0.93%) during the third measurement, which was associated with bending of the shunts due to their excessive length. All surgical errors were corrected immediately at the stage of their verification.
Conclusion. The strategy of three-stage flowmetry assessment makes it possible to ensure and document the adequate functionality of coronary bypass grafts at all stages of the operation. This allows for timely verification and immediate correction of any technical problems with coronary bypass grafts.
About the Authors
V. V. Zatolokin
Cardiology Research Institute, Tomsk National Research Medical Center, Russian Academy of Sciences
Russian Federation
Russian Federation
Cand. Sci. (Med.), Research Scientist, Department of Cardiovascular Surgery
111a, Kievskaya str., Tomsk, 634012, Russian Federation
Yu. V. Vechersky
Cardiology Research Institute, Tomsk National Research Medical Center, Russian Academy of Sciences
Russian Federation
Russian Federation
Dr. Sci. (Med.), Professor, Leading Research Scientist, Department of Cardiovascular Surgery; Professor, Department of Hospital Surgery with the Course of Cardiovascular Surgery, Siberian State Medical University
111a, Kievskaya str., Tomsk, 634012, Russian Federation
D. V. Manvelyan
Cardiology Research Institute, Tomsk National Research Medical Center, Russian Academy of Sciences
Russian Federation
Russian Federation
Cand. Sci. (Med.), Research Scientist, Department of Cardiovascular Surgery
111a, Kievskaya str., Tomsk, 634012, Russian Federation
N. L. Afanasieva
Cardiology Research Institute, Tomsk National Research Medical Center, Russian Academy of Sciences
Russian Federation
Russian Federation
Cand. Sci. (Med.), Cardiologist, Department of Cardiovascular Surgery
111a, Kievskaya str., Tomsk, 634012, Russian Federation
References
1. Thuijs D.J.F.M., Bekker M.W.A., Taggart D.P., Kappetein A.P., Kieser T.M., Wendt D. et al. Improving coronary artery bypass grafting: a systematic review and meta-analysis on the impact of adopting transit-time flow measurement. Eur. J. Cardiothorac. Surg. 2019;56(4):654–663. DOI: 10.1093/ejcts/ezz075.
2. Head S.J., Milojevic M., Daemen J., Ahn J.-M., Boersma E., Christiansen E.H..et al. Mortality after coronary artery bypass grafting versus percutaneous coronary intervention with stenting for coronary artery disease: A pooled analysis of individual patient data. Lancet. 2018;391(10124):939–948. DOI: 10.1016/S0140-6736(18)30423-9.
3. Kieser T.M., 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(2):155–162. DOI: 10.1016/j.ejcts.2010.01.026.
4. Vechersky Yu.Yu., Zatolokin V.V., Andreev S.L., Shipulin V.M. Bimammary coronary artery bypass grafting with preservation of the blood supply to the sternum. Kardiologiia. 2016;56(1):31–33 (In Russ.).
5. Vechersky Yu.Yu., Zatolokin V.V., Petlin K.A., Ahmedov Sh.D., Shipulin V.M. A new method for endoscopic isolation of the great saphenous vein in an open system. Angiology and Vascular Surgery. 2017;23(2):131–136 (In Russ.).
6. Jokinen J.J., 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;39:918–923. DOI: 10.1016/j.ejcts.2010.10.006.
7. Kieser T.M., Taggart D.P. The use of intraoperative graft assessment in guiding graft revision. Ann. Cardiothorac. Surg. 2018;7(5):652–662. DOI: 10.21037/acs.2018.07.06.
8. Kieser T.M. Graft quality verification in coronary artery bypass graft surgery: How, when and why? Curr. Opin. Cardiol. 2017;32(6):722–736. DOI: 10.1097/HCO.0000000000000452.
9. Hashim S.A., Amin M.A., Nair A.A., Mokhtar R.A.R., Krishnasamy S., Cheng K. Flowmeter technique to exclude internal mammary artery anastomosis error in an arrested heart. Heart Lung Circ. 2018;27(5):59–63. DOI: 10.1016/j.hlc.2017.11.011.
10. Hiraoka A., Fukushima S., Miyagawa S., Yoshikawa Y., Saito S., Domae K. et al. Quantity and quality of graft flow in coronary artery bypass grafting is associated with cardiac computed tomography studybased anatomical and functional parameters. Eur. J. Cardiothorac. Surg. 2017;52:909–916. DOI: 10.1093/ejcts/ezx210.
11. Neumann F-J., Sousa-Uva M., Ahlsson A., Alfonso F., Banning A.P., Benedetto U. et al. 2018 ESC/EACTS guidelines on myocardial revascularization. Eur. Heart J. 2019;40(2):87–165. DOI: 10.1093/eurheartj/ehy394.
12. Kieser T.M., Taggart D.P. Current status of intra-operative graft assessment: Should it be the standard of care for coronary artery bypass graft surgery? J. Card. Surg. 2018;33(5):219–228. DOI: 10.1111/jocs.13546.
13. Bazylev V.V., Rosseikin E.V., Mikulyak A.I., Karpunkin O.A. Doppler ultrasound flowmetry in the intraoperative diagnosis of coronary bypass graft failure. Angiology and Vascular Surgery. 2014;20(1):45–55 (In Russ.).
14. Di Giammarco G., Canosa C., Foschi M., Rabozzi R., Marinelli D., Masuyama S. et al. Intraoperative graft verification in coronary surgery: increased diagnostic accuracy adding high-resolution epicardial ultrasonography to transit-time flow measurement. Eur. J. Cardiothorac. Surg. 2014;45(3):41–45. DOI: 10.1093/ejcts/ezt580.
15. Une D., Deb S., Chikazawa G., Kommaraju K., Tsuneyoshi H., Karkhanis R. et al. Cut-off values for transit time flowmetry: Are the revision criteria appropriate? J. Card. Surg. 2013;28(1):3–7. DOI: 10.1111/jocs.12036.
16. Lehnert M., Moller C., Damgard S., Gerds T.A., Steinbrüchel D.A. Transit-time flow measurement as a predictor of coronary bypass graft failure at one year angiographic follow-up. J. Card. Surg. 2015;30(1):47–52. DOI: 10.1111/jocs.12471.
17. Wijns W., Kolh P., Danchin N., Di Mario C., Falk V., Folliguet T. et al. Guidelines on myocardial revascularization: The Task Force on Myocardial Revascularization of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS). Eur. J. Cardiothorac. Surg. 2010;31(20):2501–2555. DOI: 10.1093/eurheartj/ehq277.
18. Niclauss L. Techniques and standards in intraoperative graft verification by transit time flow measurement after coronary artery bypass graft surgery: A critical review. Eur. J. Cardiothorac. Surg. 2017;51(1):26–33. DOI: 10.1093/ejcts/ezw203.
19. Oshima H., Tokuda Y., Araki Y., Ishii H., Murohara T., Ozaki Y. et al. Predictors of early graft failure after coronary artery bypass grafting for chronic total occlusion. Interact. Cardiovasc. Thorac. Surg. 2016;23(1):142–149. DOI: 10.1093/icvts/ivw084.
20. Hatada A., Okamura Y., Kaneko M., Hisaoka T., Yamamoto S., Hiramatsu T. et al. Comparison of the waveforms of transit-time flowmetry and intraoperative fluorescence imaging for assessing coronary artery bypass graft patency. Gen. Thorac. Cardiovasc. Surg. 2011;59(1):14–18. DOI: 10.1007/s11748-010-0611-1.
21. Daniel W.T., Kilgo P., Puskas J.D., Thourani V.H., Lattouf O.M., Guyton R.A. et al. Trends in aortic clamp use during coronary artery bypass surgery: effect of aortic clamping strategies on neurologic outcomes. J. Thorac. Cardiovasc. Surg. 2014;147(2):652–657. DOI: 10.1016/j.jtcvs.2013.02.021.
22. Sidorov R.V., Talalaev E.P., Shchetko V.N., Pospelov D.Yu., Shlyk I.F. Analysis of flowmetric parameters of coronary bypass grafts blood flow in patients with high surgical risk. Angiology and Vascular Surgery. 2019;25(1):53–57 (In Russ.).
Review
For citations:
Zatolokin V.V., Vechersky Yu.V., Manvelyan D.V., Afanasieva N.L. Optimized technique for intraoperative graft verification by ultrasonic flowmetry during coronary artery bypass surgery. Siberian Journal of Clinical and Experimental Medicine. 2021;36(1):92-100. (In Russ.) https://doi.org/10.29001/2073-8552-2021-36-1-92-100
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