Transit time flow measurement predicts graft patency in off-pump coronary artery bypass grafting upon 5-year angiographic follow-up

• Published in: Journal of cardiothoracic surgery 2021-11, Vol.16 (1), p.1-334, Article 334
• Main Authors: Zeng, Caiwu, Li, Xiaomi, Dai, Yan, Zhou, Ye, Li, Chenglong, Liu, Nan, Wang, Jiangang
• Format: Article
• Language: English
• Subjects: Analysis; Angiography; Bypass; Clopidogrel; Coronary angiography; Coronary artery; Coronary artery bypass; Coronary vessels; Evaluation; Failure; Graft dysfunction; Graft rejection; Grafting; Grafts; Heart surgery; Measurement; Medical imaging; Medical research; Medicine, Experimental; Off-pump coronary artery bypass grafting; Patients; Surgery; Sutures; Time measurement; Transit time; Transit time flow measurement; Veins & arteries
• ISSN: 1749-8090; 1749-8090
• DOI: 10.1186/s13019-021-01716-3

Objective This 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. Methods Of 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. Results A 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. Conclusion LIMA 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. Keywords: Off-pump coronary artery bypass grafting, Transit time flow measurement, Coronary angiography, Graft dysfunction