Intraoperative evaluation of graft patency in off-pump coronary artery bypass grafting

ABSTRACT

The accuracy of the anastomosis in off-pump coronary artery bypass [OPCAB] is sometimes questionable due to incomplete stability of the anastomotic site and wet field. Transit time flowmetry is a new technology used to evaluate the immediate graft patency intraoperatively. This is a prospective study to evaluate the benefit of this new technology in detecting silent technical errors leading to early graft stenosis or occlusion. In a period of 22 months, a prospective study of 112 patients underwent OPCAB with total number of 308 anastomoses. All grafts were tested by transit time flowmetry. The pulsatility index [PI] and the flow pattern wave were used to evaluate the patency of the grafts. These parameters were acceptable in all but 4 grafts [1.2%]. The cause was a technical error in all 4 grafts which were revised. None of these cases required revision on the pump. ECG and hemodynamics were normal in all 4 cases. We concluded that transit time flowmetry is an effective and reliable method in detecting early anastomotic problems in the operating room. Surgeons should be encouraged to use it routinely in the operating room in off- and on- pump technique