Patient and haemodynamic factors affecting intraoperative graft flow during coronary artery bypass grafting: an observational pilot study

Sang-Wook Lee, Jun-Young Jo, Wook-Jong Kim, Dae-Kee Choi, In-Cheol Choi, Sang-Wook Lee, Jun-Young Jo, Wook-Jong Kim, Dae-Kee Choi, In-Cheol Choi

Abstract

Transit-time flow measurement (TTFM) is frequently used to evaluate intraoperative quality control during coronary artery bypass grafting (CABG) and has the ability to assess graft failure intraoperatively. However, perioperative factors affecting TTFM during CABG remain poorly understood. Patients who underwent CABG at a single institution between July 2016 and May 2018 were prospectively evaluated. TTFM and blood viscosity were measured haemodynamically, while mean flow (mL/min), pulsatility index, and diastolic filling were recorded. Arterial blood gas was analysed immediately after left internal mammary artery to left descending artery anastomosis and before sternal closure. Factors associated with TTFM were assessed using multiple linear regression analysis. We evaluated 57 of the 62 patients who underwent CABG during the study period, including 49 who underwent off-pump and 8 who underwent on-pump surgeries. Blood viscosity was not significantly associated with TTFM (p > 0.05). However, TTFM was significantly associated with body mass index, systolic blood pressure, and cardiac index (p < 0.05 each). In conclusion, maintaining the SBP in the perioperative period and maintaining the CI with inotropic support or fluid resuscitation can be important in improving blood flow of graft vessels after surgery.

Conflict of interest statement

The authors declare no competing interests.

Figures

Figure 1
Figure 1
Flow diagram of the study. TTFM transit-time flow measurement, PI pulsatility index.
Figure 2
Figure 2
Intraoperative and haemodynamic findings. T1, after anaesthesia induction. T2, after left internal mammary artery (LIMA) to left anterior descending artery (LAD) anastomosis. T3, before sternal closure. HR heart rate, SBP systolic blood pressure, DBP diastolic blood pressure, MBP mean blood pressure, CVP central venous pressure, mPAP mean pulmonary artery pressure, CI cardiac index, SVRI systemic vascular resistance index, PaCO2 partial pressure of carbon dioxide, PaO2 partial pressure of oxygen, Hb haemoglobin, Hct haematocrit.
Figure 3
Figure 3
Scatter plot showing the correlation between the three parameters of TTFM and BMI, SBP, and CI. MFR mean flow rate, PI pulsatility index, DF diastolic filling, TTFM transit-time flow measurement, BMI body mass index, SBP systolic blood pressure, CI cardiac index.
Figure 4
Figure 4
Scatter plot showing the correlation between the three parameters of TTFM and viscosity. MFR mean flow rate, PI pulsatility index, DF diastolic filling, TTFM transit-time flow measurement. Viscosity S, systolic blood viscosity; Viscosity D, diastolic blood viscosity.

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