Intraoperative graft flow measurements during coronary artery bypass surgery predict in-hospital outcomes.
Transit-time flowmetry enables immediate intraoperative assessment of blood flow parameters in coronary artery bypass grafts (CABG). The present study assesses the predictive value of measured graft flows on early and medium-term outcomes. All cardiac surgery patients with measured graft flows were included. The last intraoperative flow measurements recorded using the Medtronic Butterfly Flowmetry system were used for analysis. Patients were separated into two groups: patients with normal flow in all grafts or patients with abnormal flow > or =1 graft. Any pulsatility index (pulsatility index=min-max flow/mean flow) < or =5 was determined to be normal flow. The study population included 985 patients. Nineteen percent of patients had abnormal flow in > or =1 graft. Overall in-hospital mortality was 4.7% and not significant between the two groups. After adjusting for covariates, the in-hospital composite outcome for adverse cardiac events was more prevalent in the abnormal flow group (31% vs. 17%; P<0.0001) with an odds ratio of 1.7 (CI 1.1-2.7). Survivors to discharge had a mean follow-up of 1.8 years. However, abnormal flow was not an independent predictor of the medium-term mortality and readmission to hospital for cardiac reason following discharge. Our findings suggest that abnormal flows measured intraoperatively are independently associated with short-term in-hospital adverse outcome.
Herman
Christine
C
Department of Surgery, Division of Cardiac Surgery, Dalhousie University, Halifax, NS, Canada.
Sullivan
John A
JA
Buth
Karen
K
Legare
Jean-Francois
JF
D000368:Aged; D001783:Blood Flow Velocity; D002318:Cardiovascular Diseases / Q000175:diagnosis* / Q000209:etiology / Q000401:mortality / Q000503:physiopathology; D001026:Coronary Artery Bypass / Q000009:adverse effects* / Q000401:mortality; D003326:Coronary Circulation; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007430:Intraoperative Care; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D011673:Pulsatile Flow; D012086:Reoperation; D012212:Rheology / Q000379:methods*; D018570:Risk Assessment; D013997:Time Factors; D016896:Treatment Outcome