title: Intraoperative color Doppler ultrasound assessment of LIMA-to-LAD anastomoses in off-pump coronary artery bypass grafting.
abstract: BACKGROUND
  Although techniques for off-pump coronary artery bypass grafting (CABG) are continually being refined, angiographic follow-up studies have indicated a higher rate of anastomoses-related stenoses than expected after traditional on-pump CABG. This study was performed to evaluate the use of intraoperative epicardial color Doppler ultrasound to quality-assess left internal mammary artery (LIMA) to left anterior descending coronary artery (LAD) anastomoses performed on the beating heart.
  
  
  METHODS
  Twenty-four LIMA-to-LAD anastomoses were evaluated with real-time epicardial ultrasound imaging using an ultrasound transducer positioned between the paddles of the stabilizer during off-pump procedures. The length of the anastomosis (D(A)), diameters of LIMA (D(M)), LAD at the toe of the anastomosis (D1), and 5 mm distally to the anastomosis (D2) were measured, and the ratios between these variables were calculated. The flow velocity through the anastomoses was visualized by color Doppler coding, and flow was assessed with transit-time flowmetry.
  
  
  RESULTS
  The epicardial color Doppler ultrasound allowed accurate assessment of the anastomoses. Twenty-three (96%) of the primary anastomoses were confirmed as patent. Mean ratios of D1/D2, D(A)/D2, and D(M)/D2 were 0.89 +/- 0.13, 3.01 +/- 1.04 and 1.32 +/- 0.32, respectively. One anastomosis had a stenosis more than 50% detected by color Doppler ultrasound. After surgical revision, transit-time flow increased from 22 to 40 ml/min.
  
  
  CONCLUSIONS
  Intraoperative color Doppler ultrasound allowed adequate imaging for quality assessment of LIMA-to-LAD anastomoses performed on the beating heart. One anastomosis was revised due to a technical error detected by epicardial color Doppler imaging. Epicardial ultrasound scanning is a valuable tool for intraoperative assessment of LIMA-to-LAD anastomoses during off-pump coronary surgery.
authors.affiliation: St. Elisabeth Heart Center and Institute of Physiology and Biomedical Engineering, Norwegian University of Science and Technology, Trondheim. rune.haaverstad@medisin.ntnu.no
authors.forename: Rune
authors.initials: R
authors.lastname: Haaverstad
authors.forename: Nicola
authors.initials: N
authors.lastname: Vitale
authors.forename: Ole
authors.initials: O
authors.lastname: Tjomsland
authors.forename: Arve
authors.initials: A
authors.lastname: Tromsdal
authors.forename: Hans
authors.initials: H
authors.lastname: Torp
authors.forename: Stein O
authors.initials: SO
authors.lastname: Samstad
mesh_terms: D000714:Anastomosis, Surgical; D001783:Blood Flow Velocity; D001026:Coronary Artery Bypass / Q000379:methods*; D003331:Coronary Vessels / Q000000981:diagnostic imaging / Q000601:surgery*; D005260:Female; D006801:Humans; D007432:Intraoperative Period; D008297:Male; D008323:Mammary Arteries / Q000000981:diagnostic imaging / Q000601:surgery*; D008875:Middle Aged; D010496:Pericardium; D018615:Ultrasonography, Doppler, Color