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The Relationship Between Intraoperative Flow Parameters And Arterial Graft Patency In Computer Tomography Angigraphy Assessment After CABG.
Jakub Zieliński, Krzysztof Wróbel.
Medicover Hospital, Warsaw, Poland.
OBJECTIVE: Intraoperative transit-time flow measurement (TTFM) is widely used during coronary artery bypass grafting (CABG) to assess the quality of arterial grafts. However, its long-term predictive value remains uncertain. This study aimed to evaluate the association between TTFM parameters and graft patency assessed by coronary computed tomography angiography (CTA), with additional analysis of sequential versus single radial artery (RA) grafts.
METHODS: A total of 89 consecutive patients who underwent CABG with total arterial grafts including radial artery, were prospectively enrolled. Intraoperative TTFM parameters (mean graft flow (MGF), pulsatility index (PI) were collected for 186 grafts. CTA was performed between 12 and 24 months postoperatively (mean 19 ± 0.5 months). Graft patency was defined as patent (including <50% stenosis) or occluded according to the Fitzgibbon patency scale. Statistical analysis included the Mann-Whitney U test to compare TTFM values between patent and occluded grafts.
RESULTS: The overall graft occlusion rate was 13.97%. No statistically significant difference was observed in MGF or PI between patent and occluded grafts (p > 0.05 for both comparisons). In 5 coronary arteries with occluded grafts , CTA showed non-significant stenoses. 11 (44%) coronary vessels with failed grafts were subsequently treated with percutaneous coronary intervention (PCI).
CONCLUSIONS: In this cohort, intraoperative TTFM parameters did not correlate significantly with graft patency on mid-term CTA follow-up. Although TTFM remains a useful intraoperative tool, its ability to predict long-term outcomes may be limited. The role of graft configuration, including sequential RA grafts, requires further investigation. The authors recommend routinely performing CTA in all patients after CABG to detect clinically silent graft dysfunction and to plan appropriate treatment.
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