Study summary · research use only
Intraoperative graft verification in coronary surgery
Plain-language summary
Paraphrased from the published abstract below — not a verdict on whether anything works.
This report combines a systematic literature review with the authors' own experience of intraoperative graft verification in coronary surgery (species not specified). It describes transit-time flow measurement (TTFM), producing Mean Graft Flow (MGF), Pulsatility Index (PI), and Insufficiency Ratio (%BF), and cites reported cutoffs linked to 1-y clinical outcome (MGF less than 20 ml/min, PI greater than 5) and to postoperative angiography: MGF 15 ml/min or less with PI at least 3 (sensitivity 94%; specificity 61%); MGF less than 15 ml/min with PI greater than 3 (left coronary artery) or PI greater than 5 (right coronary artery) (sensitivity 96%; specificity 77%); and MGF 15 ml/min or less with PI at least 5.1 (sensitivity 98%; specificity 26%). The report also discusses adding high-resolution epicardic ultrasound imaging to graft evaluation.
Abstract
Transit-time flow measurement (TTFM) is a reliable method to check the graft function intraoperatively in coronary surgery. The given parameters are: Mean Graft Flow (MGF); Pulsatility Index (PI) and Insufficiency Ratio (%BF). Some cutoffs of these parameters have been identified as predictors for unfair 1-y clinical outcome: mean graft flow (MGF) less than 20 ml/min and high pulsatility index greater than 5. Other cutoffs have been found as related to postoperative angiography: MGF 15 ml/min or less and pulsatility index at least 3 (sensitivity 94%; specificity 61%); MGF less than 15 ml/min and pulsatility index greater than 3 for left coronary artery or pulsatility index greater than 5 for right coronary artery (sensitivity 96%; specificity 77%); MGF 15 ml/min or less and pulsatility index at least 5.1 left coronary artery (sensitivity 98%; specificity 26%). Hence, with the need to improve the diagnostic accuracy of TTFM, high-resolution epicardic coronary ultrasound module has been added to graft flow evaluation providing 2D ultrasound imaging (either in short-axis or long-axis) and color-flow mapping, allowing an accurate morphological evaluation of body graft and anastomosis. An intraoperative method aimed to verify coronary grafts should be easy to handle, not time consuming, minimally invasive, easily meaningful and relatively cheap; in addition, it should offer objective parameters more than qualitative criteria. We herein report the results of our experience with intraoperative graft verification with TTFM and high-resolution imaging along with a systematic review of the literature in this field with the aim to provide a road map to be followed.
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