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The application of intraoperative transit time flow measurement to accurately assess anastomotic quality in sequential vein grafting

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机构: [1]Capital Med Univ, Beijing An Zhen Hosp, Dept Cardiac Surg, Beijing 100029, Peoples R China
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关键词: Sequential saphenous coronary artery bypass grafting Transit time flow measurement Anastomotic quality

摘要:
Intraoperative transit time flow measurement (TTFM) is widely used to assess anastomotic quality in coronary artery bypass grafting (CABG). However, in sequential vein grafting, the flow characteristics collected by the conventional TTFM method are usually associated with total graft flow and might not accurately indicate the quality of every distal anastomosis in a sequential graft. The purpose of our study was to examine a new TTFM method that could assess the quality of each distal anastomosis in a sequential graft more reliably than the conventional TTFM approach. Two TTFM methods were tested in 84 patients who underwent sequential saphenous off-pump CABG in Beijing An Zhen Hospital between April and August 2012. In the conventional TTFM method, normal blood flow in the sequential graft was maintained during the measurement, and the flow probe was placed a few centimetres above the anastomosis to be evaluated. In the new method, blood flow in the sequential graft was temporarily reduced during the measurement by placing an atraumatic bulldog clamp at the graft a few centimetres distal to the anastomosis to be evaluated, while the position of the flow probe remained the same as in the conventional method. This new TTFM method was named the flow reduction TTFM. Graft flow parameters measured by both methods were compared. Compared with the conventional TTFM, the flow reduction TTFM resulted in significantly lower mean graft blood flow (P < 0.05); in contrast, yielded significantly higher pulsatility index (P < 0.05). Diastolic filling was not significantly different between the two methods and was > 50% in both cases. Interestingly, the flow reduction TTFM identified two defective middle distal anastomoses that the conventional TTFM failed to detect. Graft flows near the defective distal anastomoses were improved substantially after revision. In this study, we found that temporary reduction of graft flow during TTFM seemed to enhance the sensitivity of TTFM to less-than-critical anastomotic defects in a sequential graft and to improve the overall accuracy of the intraoperative assessment of anastomotic quality in sequential vein grafting.

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出版当年[2012]版:
最新[2023]版:
大类 | 4 区 医学
小类 | 4 区 心脏和心血管系统 4 区 呼吸系统 4 区 外科
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出版当年[2011]版:
最新[2023]版:
Q2 SURGERY Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Q3 RESPIRATORY SYSTEM

影响因子: 最新[2023版] 最新五年平均 出版当年[2011版] 出版当年五年平均 出版前一年[2010版] 出版后一年[2012版]

第一作者:
第一作者机构: [1]Capital Med Univ, Beijing An Zhen Hosp, Dept Cardiac Surg, Beijing 100029, Peoples R China
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通讯机构: [1]Capital Med Univ, Beijing An Zhen Hosp, Dept Cardiac Surg, Beijing 100029, Peoples R China
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