David P Taggart1, Daniel J F M Thuijs2, Gabriele Di Giammarco3, John D Puskas4, Daniel Wendt5, Gregory D Trachiotis6, Teresa M Kieser7, A Pieter Kappetein2, Stuart J Head8. 1. Department of Cardiac Surgery, John Radcliffe Hospital, University of Oxford, Oxford, United Kingdom. 2. Department of Cardiothoracic Surgery, Erasmus University Medical Centre, Rotterdam, The Netherlands. 3. Department of Cardiac Surgery, Università degli Studi "G. D'Annunzio" Chieti-Pescara, Chieti, Italy. 4. Department of Cardiovascular Surgery, Mount Sinai Saint Luke's, New York, NY. 5. Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center, University of Duisburg-Essen, Duisburg, Germany. 6. Division of Cardiothoracic Surgery, Veterans Affairs Medical Center, Washington, DC. 7. Division of Cardiac Surgery, Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada. 8. Department of Cardiothoracic Surgery, Erasmus University Medical Centre, Rotterdam, The Netherlands. Electronic address: s.head@erasmusmc.nl.
Abstract
OBJECTIVES: We evaluated the influence of transit-time flow measurement with epicardial and epiaortic high-frequency ultrasound in patients undergoing coronary artery bypass grafting procedure. METHODS: The Registry for Quality Assessment with Ultrasound Imaging and Transit-time Flow Measurement in Cardiac Bypass Surgery study is a multicenter, prospective study among 7 international centers performing coronary artery bypass grafting procedures. The primary end point was any change in the planned surgical procedure. Major secondary end points consisted of the rate and reason for surgical changes related to the aorta, in situ conduits, coronary targets, and completed grafts, and the rate of in-hospital mortality and major morbidity. RESULTS: Between April 2015 and December 2017, 1046 patients were enrolled. Of those, 1016 were included in the final analyses. Mean age was 65.9 years, 14.0% were women, and diabetes was present in 39.6%. Off-pump procedures were performed in 39.6% and bilateral internal thoracic arteries in 30.5%. The primary end point occurred in 25.2% of patients (n = 256) and in 77% (197 out of 256) this was based on transit-time flow measurement and/or high-frequency ultrasound. Surgical changes were related to the aorta in 9.9%, to in situ conduits in 2.7%, and the coronary targets in 22.6%. Graft revision occurred in 7.8%, including revisions of the proximal and/or distal anastomosis in 6.6%. In-hospital adverse event rates were 0.6% for mortality, 1.0% for cerebrovascular events, and 0.3% for myocardial infarction. CONCLUSIONS: Surgical changes related to the aorta, conduits, coronary targets, and anastomosis were made in 25% of patients. This was associated with low operative mortality and low major morbidity. Transit-time flow measurement and high-frequency ultrasound may improve the quality, safety, and efficacy of coronary artery bypass grafting procedures and should be considered as a routine procedural aspect.
OBJECTIVES: We evaluated the influence of transit-time flow measurement with epicardial and epiaortic high-frequency ultrasound in patients undergoing coronary artery bypass grafting procedure. METHODS: The Registry for Quality Assessment with Ultrasound Imaging and Transit-time Flow Measurement in Cardiac Bypass Surgery study is a multicenter, prospective study among 7 international centers performing coronary artery bypass grafting procedures. The primary end point was any change in the planned surgical procedure. Major secondary end points consisted of the rate and reason for surgical changes related to the aorta, in situ conduits, coronary targets, and completed grafts, and the rate of in-hospital mortality and major morbidity. RESULTS: Between April 2015 and December 2017, 1046 patients were enrolled. Of those, 1016 were included in the final analyses. Mean age was 65.9 years, 14.0% were women, and diabetes was present in 39.6%. Off-pump procedures were performed in 39.6% and bilateral internal thoracic arteries in 30.5%. The primary end point occurred in 25.2% of patients (n = 256) and in 77% (197 out of 256) this was based on transit-time flow measurement and/or high-frequency ultrasound. Surgical changes were related to the aorta in 9.9%, to in situ conduits in 2.7%, and the coronary targets in 22.6%. Graft revision occurred in 7.8%, including revisions of the proximal and/or distal anastomosis in 6.6%. In-hospital adverse event rates were 0.6% for mortality, 1.0% for cerebrovascular events, and 0.3% for myocardial infarction. CONCLUSIONS: Surgical changes related to the aorta, conduits, coronary targets, and anastomosis were made in 25% of patients. This was associated with low operative mortality and low major morbidity. Transit-time flow measurement and high-frequency ultrasound may improve the quality, safety, and efficacy of coronary artery bypass grafting procedures and should be considered as a routine procedural aspect.
Authors: Mario F L Gaudino; Sigrid Sandner; Giorgia Bonalumi; Jennifer S Lawton; Stephen E Fremes Journal: Eur J Cardiothorac Surg Date: 2020-12-01 Impact factor: 4.191
Authors: Dror B Leviner; Miriam von Mücke Similon; Carlo Maria Rosati; Andrea Amabile; Daniel J F M Thuijs; Gabriele Di Giammarco; Daniel Wendt; Gregory D Trachiotis; Teresa M Kieser; A Pieter Kappetein; Stuart J Head; David P Taggart; John D Puskas Journal: J Cardiothorac Surg Date: 2021-07-09 Impact factor: 1.637