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Intra-operative quality assessment of coronary artery bypass grafts

Cardiac Surgery Department, Maine Medical Center, Portland, Maine, groomr{at}mail.mmc.org

Joan Tryzelaar

Cardiac Surgery Department, Maine Medical Center, Portland, Maine

Richard Forest

Cardiac Surgery Department, Maine Medical Center, Portland, Maine

Kevin Niimi

Cardiac Surgery Department, Maine Medical Center, Portland, Maine

Giovanni Cecere

Cardiac Surgery Department, Maine Medical Center, Portland, Maine

Desmond Donegan

Cardiac Surgery Department, Maine Medical Center, Portland, Maine

Saul Katz

Cardiac Surgery Department, Maine Medical Center, Portland, Maine

Paul Weldner

Cardiac Surgery Department, Maine Medical Center, Portland, Maine

Reed Quinn

Cardiac Surgery Department, Maine Medical Center, Portland, Maine

John Braxton

Cardiac Surgery Department, Maine Medical Center, Portland, Maine

Seth Blank

Cardiac Surgery Department, Maine Medical Center, Portland, Maine

Robert Kramer

Cardiac Surgery Department, Maine Medical Center, Portland, Maine

Jeremy Morton

Cardiac Surgery Department, Maine Medical Center, Portland, Maine

Early coronary artery bypass graft (CABG) failure is a troubling complication that may result in a wide range of problems, including refractory angina, myocardial infarction, low cardiac output, arrhythmia, and fatal heart failure. Early graft failures are related to poor quality and size of the distal native vascular bed, coagulation abnormalities, or technical problems involving the graft conduits and anastomoses. Unfortunately, graft failure is difficult to detect during surgery by visual assessment, palpation, or conventional monitoring. We evaluated the accuracy and utility of a transit-time, ultrasonic flow measurement system for measurement of CABGs. There were no differences between transit-time measurements and volumetric-time collected samples in an in vitro circuit over a range of flows from 10 to 100 ml/min (Bland and Altman Plot, 1.96 SD). Two hundred and ninety-eight CABGs were examined in 125 patients.

Graft flow rate was proportional to the target vessel diameter. Nine technical errors were detected and corrected. Flow waveform morphology provided valuable information related to the quality of the anastamosis, which led to the immediate correction of technical problems at the time of surgery.

Perfusion, Vol. 16, No. 6, 511-518 (2001)
DOI: 10.1177/026765910101600611


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