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Halfwerk FR, Spoor P, Mariani S, et al. Intraoperative transit time flow measurements during off-pump coronary artery bypass surgery: The impact of coronary stenosis on competitive flow. J Card Surg. 2021;doi: 10.1111/jocs.16103.
Halfwerk, F. R., Spoor, P., Mariani, S., Hagmeijer, R., & Grandjean, J. G. (2021). Intraoperative transit time flow measurements during off-pump coronary artery bypass surgery: The impact of coronary stenosis on competitive flow. Journal of cardiac surgery, . https://doi.org/10.1111/jocs.16103
Halfwerk, Frank R, et al. "Intraoperative transit time flow measurements during off-pump coronary artery bypass surgery: The impact of coronary stenosis on competitive flow." Journal of cardiac surgery vol. (2021). doi: https://doi.org/10.1111/jocs.16103
Halfwerk FR, Spoor P, Mariani S, Hagmeijer R, Grandjean JG. Intraoperative transit time flow measurements during off-pump coronary artery bypass surgery: The impact of coronary stenosis on competitive flow. J Card Surg. 2021 Oct 21; doi: 10.1111/jocs.16103. Epub 2021 Oct 21. PMID: 34676586.
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J Card Surg. 2021 Oct 21; doi: 10.1111/jocs.16103. Epub 2021 Oct 21.

Intraoperative transit time flow measurements during off-pump coronary artery bypass surgery: The impact of coronary stenosis on competitive flow.

Journal of cardiac surgery

Frank R Halfwerk, Pien Spoor, Silvia Mariani, Rob Hagmeijer, Jan G Grandjean

Affiliations

  1. Department of Cardio-Thoracic Surgery, Thoraxcentrum Twente, Medisch Spectrum Twente, Enschede, The Netherlands.
  2. Department of Biomechanical Engineering, Faculty of Engineering Technology, University of Twente, Enschede, The Netherlands.
  3. Department of Cardio-Thoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre (MUMC), Maastricht, The Netherlands.
  4. Department of Engineering Fluid Dynamics, Faculty of Engineering Technology, University of Twente, Enschede, The Netherlands.

PMID: 34676586 DOI: 10.1111/jocs.16103

Abstract

BACKGROUND: Combining preoperative angiography findings with intraoperative transit time flow measurements (TTFM) may improve patency of coronary artery bypass grafts. Nevertheless, graft flow might be impaired by native coronary flow based on the severity of stenoses, with inferior long-term outcomes. This study investigates the impact of left anterior descending artery (LAD) stenosis on competitive flow measured in left internal mammary artery (LIMA) grafts during off-pump coronary artery bypass grafting.

METHODS: Fifty patients were included in this prospective single-center cohort study. LAD stenosis was assessed with quantitative coronary analysis (QCA) and stratified into three groups based on its severity. TTFM of LIMA grafts were performed with LAD open and temporarily occluded. Change in mean graft flow after LAD snaring was the primary endpoint. Secondary endpoints included further TTFM parameters, clinical outcomes, and competitive flow index (CFI), defined as the ratio of mean graft flow with open or closed LAD.

RESULTS: Mean LAD stenosis as objectified with QCA was 58 ± 15%. Mean LIMA graft flow increased from 20 ml/min with open LAD to 30 ml/min with snared LAD (p < .001). TTFM cut-off values for graft patency improved in 26%-42% of patients after LAD occlusion. Median CFI was 0.66 (IQR: 0.56-0.82). Postoperative myocardial infarction occurred in 2.0% of patients, 120-day mortality was 0%, and 2-year mortality was 6.0%.

CONCLUSIONS: Routine snaring of the LAD with CFI calculation during coronary artery bypass grafting is useful to detect significant competitive flow in LIMA grafts, potentially preventing unnecessary intraoperative graft revisions.

© 2021 The Authors. Journal of Cardiac Surgery published by Wiley Periodicals LLC.

Keywords: CABG; arterial grafts; coronary artery disease; minimally invasive surgery; off-pump coronary artery bypass grafting

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