Intraoperative evaluation of coronary anastomosis by transit-time ultrasonic flow measurement.
BACKGROUND
Intraoperative assessment of the anastomosis is important during coronary bypass on a beating heart. The purpose of this study is to predict the quality of anastomosis using transit-time flow measurement and to find out the most accurate indicator.


METHODS
Eight swine underwent internal thoracic-anterior descending coronary artery bypass grafting on a beating heart. Flow measurement and angiography were performed at various degrees of stenosis created on the graft. As flow parameters, total flow, systolic flow, diastolic flow, diastolic/total flow ratio, systolic peak flow, diastolic peak flow, systolic/diastolic peak flow index, and pulsatility index were used. Mixed procedure and probability test (negative means successful anastomosis) were used to analyze the diagnostic ability.


RESULTS
Diastolic flow, diastolic/total flow ratio, diastolic peak flow, systolic/diastolic peak flow index, and pulsatility index showed significant variance with increased stenosis. Among these measures, diastolic/total flow ratio showed the highest value of area under the curve (0.91) and the highest specificity (82%) at 90% sensitivity with actual value of 42%.


CONCLUSIONS
Diastolic/total flow ratio was the most reliable indicator to predict critical stenosis in coronary artery bypass grafting.
Morota
Tetsuro
T
Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA. morotat-sur@h.u-tokyo.ac.jp
Duhaylongsod
Francis G
FG
Burfeind
William R
WR
Huang
Ching-Tsorng
CT
D000714:Anastomosis, Surgical / Q000379:methods*; D000818:Animals; D001783:Blood Flow Velocity / Q000502:physiology*; D001026:Coronary Artery Bypass / Q000379:methods*; D003326:Coronary Circulation / Q000502:physiology*; D003971:Diastole / Q000502:physiology; D015150:Echocardiography, Doppler; D008297:Male; D019060:Minimally Invasive Surgical Procedures; D011673:Pulsatile Flow / Q000502:physiology; D013552:Swine; D013599:Systole / Q000502:physiology