Display options
Cite
D'Alessio A, Akoumianakis I, Kelion A, et al. Graft flow assessment and early coronary artery bypass graft failure: a computed tomography analysis. Interact Cardiovasc Thorac Surg. 2021;doi: 10.1093/icvts/ivab298.
D'Alessio, A., Akoumianakis, I., Kelion, A., Terentes-Printzios, D., Lucking, A., Thomas, S., Verdichizzo, D., Keiralla, A., Antoniades, C., & Krasopoulos, G. (2021). Graft flow assessment and early coronary artery bypass graft failure: a computed tomography analysis. Interactive cardiovascular and thoracic surgery, . https://doi.org/10.1093/icvts/ivab298
D'Alessio, Andrea, et al. "Graft flow assessment and early coronary artery bypass graft failure: a computed tomography analysis." Interactive cardiovascular and thoracic surgery vol. (2021). doi: https://doi.org/10.1093/icvts/ivab298
D'Alessio A, Akoumianakis I, Kelion A, Terentes-Printzios D, Lucking A, Thomas S, Verdichizzo D, Keiralla A, Antoniades C, Krasopoulos G. Graft flow assessment and early coronary artery bypass graft failure: a computed tomography analysis. Interact Cardiovasc Thorac Surg. 2021 Oct 27; doi: 10.1093/icvts/ivab298. Epub 2021 Oct 27. PMID: 34718571.
Copy Download .nbib Format: NLM
Share it on

Interact Cardiovasc Thorac Surg. 2021 Oct 27; doi: 10.1093/icvts/ivab298. Epub 2021 Oct 27.

Graft flow assessment and early coronary artery bypass graft failure: a computed tomography analysis.

Interactive cardiovascular and thoracic surgery

Andrea D'Alessio, Ioannis Akoumianakis, Andrew Kelion, Dimitrios Terentes-Printzios, Andrew Lucking, Sheena Thomas, Danilo Verdichizzo, Amar Keiralla, Charalambos Antoniades, George Krasopoulos

Affiliations

  1. Department of Cardiothoracic Surgery, Oxford University Hospital NHS Foundation Trust, Oxford, UK.
  2. Cardiovascular Medicine Division, University of Oxford, Oxford, UK.
  3. Department of Cardiology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.
  4. Department of Cardiac Anesthesia, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.

PMID: 34718571 DOI: 10.1093/icvts/ivab298

Abstract

OBJECTIVES: We evaluated graft patency by computed tomography and explored the determinants of intraoperative mean graft flow (MGF) and its contribution to predict early graft occlusion.

METHODS: One hundred and forty-eight patients under a single surgeon were prospectively enrolled. Arterial and endoscopically harvested venous conduits were used. Intraoperative graft characteristics and flows were collected. Graft patency was blindly evaluated by a follow-up computed tomography at 11.4 weeks (median).

RESULTS: Graft occlusion rate was 5.2% (n = 22 of 422; 8% venous and 3% arterial). Thirteen were performed on non-significant proximal stenosis while 9 on occluded or >70% stenosed arteries. Arterial and venous graft MGF were lower in females (Parterial = 0.010, Pvenous = 0.009), with median differences of 10 and 13.5 ml/min, respectively. Arterial and venous MGF were associated positively with target vessel diameter ≥1.75 mm (Parterial = 0.025; Pvenous = 0.002) and negatively with pulsatility index (Parterial < 0.001; Pvenous < 0.001). MGF was an independent predictor of graft occlusion, adjusting for EuroSCORE-II, pulsatility index, graft size and graft type (arterial/venous). An MGF cut-off of 26.5 ml/min for arterial (sensitivity 83.3%, specificity 80%) and 36.5 ml/min for venous grafts (sensitivity 75%, specificity 62%) performed well in predicting early graft occlusion.

CONCLUSIONS: We demonstrate that MGF absolute values are influenced by coronary size, gender and graft type. Intraoperative MGF of >26.5 ml/min for arterial and >36.5 ml/min for venous grafts is the most reliable independent predictor of early graft patency. Modern-era coronary artery bypass graft is associated with low early graft failure rates when transit time flow measurement is used to provide effective intraoperative quality assurance.

© The Author(s) 2021. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery.

Keywords: Computed tomography angiography; Coronary artery bypass graft; Endoscopic vein harvesting; Graft failure; Intraoperative graft flow; Transit time flow measurement

Publication Types