| A New Index of Intraoperative Transit-Time Flow Evaluation in Coronary Artery Bypass Grafting |
(Division of Cardiovascular Surgery, Kasugai Municipal Hospital, Kasugai, Japan)
| Yoshiyuki Takami |
Hiroshi Masumoto |
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It is essential to evaluate the quality of coronary artery bypass grafting (CABG) anastomosis in the operating room. Transit-time flow measurement has been increasingly used for this purpose, because it is less invasive, more reproducible, and less time consuming. The electrocardiogram-gated flow measurement has made it possible to identify the systolic flow (Qs) and diastolic flow (Qd) and to calculate a new index, diastolic filling index （DFI＝100∫Qd／［∫｜Qs｜＋∫｜Qd｜］） for graft flow analysis. In this study, we investigated the clinical significance of DFI, together with other indexes, including mean flow (Qm), pulsatility index (PI)，% insufficiency (INSUF), and F0/H1, where F0 is a power of the fundamental frequency and H1 is a power of the first harmonic in spectral analysis by fast Fourier transformation of the flow curve. We examined the relationships of these intraoperative flow variables of the post-operative angiographic findings of 125 CABG grafts, including 58 in-situ internal thoracic arteries. There were significant differences between patent and non-patent grafts in all of the intraoperative flow parameters (Qm: 47.9±31.8ml/min vs 10.2±3.6ml/min, PI: 3.0±1.4 vs 9.6±2.4, INSUF: 3.3±4.2% vs 29.9±8.1%, F0/H1: 2.8±2.0 vs 0.6±0.2, DFI: 68.5±8.4% vs 38.2±17.2%). Our data suggested that a DFI value of more than 50% can be useful for surgeons to distinguish patent from non-patent grafts in the operating room, in combination with other parameters: Qm＞15 ml/min, PI＜5, INSUF＜15%, and F0/H1 ratio＞1.0.
Jpn. J. Cardiovasc. Surg. 35: 5-9 (2006) |
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