Importance of Intraoperative Detection of Graft Patency by Using Transit Time Flowmetry and Its Impact on Revascularization of the Myocardium

Abstract

oronary artery bypass surgery (CABG) has contributed to an increase in survival, quality of life and life expectancy. The anastomotic quality and graft patency is directly associated with both early and long-term clinical results after CABG. It is a complication that can lead to refractory angina, myocardial infarction, arrhythmias, and even mortality. Although most surgeons believe it to be a rare occurrence, the incidence of perioperative graft failure has been estimated to be from 5 to 11%. It was traditionally common for surgeons to determine the adequacy of anastomosis by crude evaluation such as palpitation of graft pulsation, to assess hemodynamic stability and electrocardiographic chances. But this method is unreliable and indirect. Therefore, it is critical for surgeons to directly evaluate the quality of anastomosis in CABG. To increase the reliability of the graft patency several methods have been introduced over the last decade including coronary angiography, fluorescence imaging, CT angiography, Magnetic Resonance Imaging (MRI) and TTFM. Transit time flow measurement (TTFM) has been reported to be a suitable method for easy and quick intraoperative functional assessment of bypass grafts, independent of vessel size and shape. Recently 20% of cardiac surgeons use TTFM to assess the graft. Since 2010.