title: Accurate preoperative echocardiography has more impact on prediction of long-term mortality than intra-operatively measured flow in coronary bypass grafts.
abstract: OBJECTIVE
  Our study aimed to analyze the predictive value of intra-operative bypass graft flow measurements for long-term mortality.
  
  
  METHODS
  A total of 1593 consecutive coronary artery bypass graft (CABG) patients routinely underwent intra-operative bypass graft flow measurements with the transit-time flow meter (TTFM: Cardiomed(®)). The results of the flow measurements and the demographics were analyzed retrospectively.
  
  
  RESULTS
  The mean follow-up was 3.8 years (0.5-8.8 years) with no losses to follow-up. Overall mortality was 10.1%. The preoperative left ventricular ejection fraction (LVEF) (echocardiograph) was the highest independent predictor of long-term survival (hazard ratio 0.97, p = 0.004) in all groups. The univariate analysis for the CABG I group showed that besides LVEF, female gender (hazard ratio 3.6, p = 0.02) was also significant. For the CABG II group, additive EuroSCORE (European System for Cardiac Operative Risk) (ES) (hazard ratio 1.4, p = 0.0001) and age (hazard ratio 1.1, p = 0.001) were significant. In the CABG III group, ES (hazard ratio 1.2, p < 0.0001), age (hazard ratio 1.04, p = 0.001), IMA (hazard ratio 0.5, p < 0.0001) and concomitant aortic valve replacement (AVR) (hazard ratio 2.1, p = 0.03) were significant, in addition to the LVEF.
  
  
  CONCLUSIONS
  With quality-controlled surgeons checked by intra-operative TTFM, accurate quantification of preoperative LVEF significantly predicts long-term outcome. Effective bypass graft flows failed to predict outcome in CABG patients, regardless of the degree of coronary artery disease (CAD) and concomitant AVR.
authors.affiliation: Division of Cardiac Surgery, Medical University Graz, Graz, Austria. elisabeth.beran@medunigraz.at
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Beran
authors.forename: Magdalena
authors.initials: M
authors.lastname: Kapitan
authors.forename: Heinrich
authors.initials: H
authors.lastname: Mächler
authors.forename: Luay
authors.initials: L
authors.lastname: Salaymeh
authors.forename: Michael
authors.initials: M
authors.lastname: Anelli-Monti
authors.forename: Peter
authors.initials: P
authors.lastname: Oberwalder
authors.forename: Andrea
authors.initials: A
authors.lastname: Berghold
authors.forename: Karlheinz
authors.initials: K
authors.lastname: Tscheliessnigg
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001026:Coronary Artery Bypass / Q000379:methods*; D003326:Coronary Circulation / Q000502:physiology; D003327:Coronary Disease / Q000503:physiopathology / Q000601:surgery*; D015150:Echocardiography, Doppler / Q000379:methods; D004812:Epidemiologic Methods; D005260:Female; D006801:Humans; D007430:Intraoperative Care / Q000379:methods; D008297:Male; D008875:Middle Aged; D011300:Preoperative Care / Q000379:methods*; D011379:Prognosis; D012737:Sex Factors; D013318:Stroke Volume / Q000502:physiology; D016896:Treatment Outcome; D016277:Ventricular Function, Left / Q000502:physiology*