1
|
Thuijs DJFM, Bekker MWA, Taggart DP, Kappetein AP, Kieser TM, Wendt D, Di Giammarco G, Trachiotis GD, Puskas JD, Head SJ. Improving coronary artery bypass grafting: a systematic review and meta-analysis on the impact of adopting transit-time flow measurement. Eur J Cardiothorac Surg 2020; 56:654-663. [PMID: 30907418 PMCID: PMC6751409 DOI: 10.1093/ejcts/ezz075] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Revised: 01/18/2019] [Accepted: 02/11/2019] [Indexed: 12/11/2022] Open
Abstract
![]()
Despite there being numerous studies of intraoperative graft flow assessment by transit-time flow measurement (TTFM) on outcomes after coronary artery bypass grafting (CABG), the adoption of contemporary TTFM is low. Therefore, on 31 January 2018, a systematic literature search was performed to identify articles that reported (i) the amount of grafts classified as abnormal or which were revised or (ii) an association between TTFM and outcomes during follow-up. Random-effects models were used to create pooled estimates with 95% confidence intervals (CI) of (i) the rate of graft revision per patient, (ii) the rate of graft revision per graft and (iii) the rate of graft revision among grafts deemed abnormal based on TTFM parameters. The search yielded 242 articles, and 66 original articles were included in the systematic review. Of those articles, 35 studies reported on abnormal grafts or graft revisions (8943 patients, 15 673 grafts) and were included in the meta-analysis. In 4.3% of patients (95% CI 3.3–5.7%, I2 = 73.9) a revision was required and 2.0% of grafts (95% CI 1.5–2.5%; I2 = 66.0) were revised. The pooled rate of graft revisions among abnormal grafts was 25.1% (95% CI 15.5–37.9%; I2 = 80.2). Studies reported sensitivity ranging from 0.250 to 0.457 and the specificity from 0.939 to 0.984. Reported negative predictive values ranged from 0.719 to 0.980 and reported positive predictive values ranged from 0.100 to 0.840. This systematic review and meta-analysis showed that TTFM could improve CABG procedures. However, due to heterogeneous data, drawing uniform conclusions appeared challenging. Future studies should focus on determining the optimal use of TTFM and assessing its diagnostic accuracy.
Collapse
Affiliation(s)
- Daniel J F M Thuijs
- Department of Cardiothoracic Surgery, Erasmus MC, University Medical Centre, Rotterdam, Netherlands
| | - Margreet W A Bekker
- Department of Cardiothoracic Surgery, Erasmus MC, University Medical Centre, Rotterdam, Netherlands
| | - David P Taggart
- Department of Cardiovascular Surgery, University of Oxford, John Radcliffe Hospital, Oxford, UK
| | - A Pieter Kappetein
- Department of Cardiothoracic Surgery, Erasmus MC, University Medical Centre, Rotterdam, Netherlands
| | - Teresa M Kieser
- Division of Cardiac Surgery, Department of Cardiac Sciences, Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Canada
| | - Daniel Wendt
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Centre, University of Duisburg-Essen, Duisburg, Germany
| | - Gabriele Di Giammarco
- Department of Cardiac Surgery, Università degli Studi "G. D'Annunzio" Chieti-Pescara, Chieti, Italy
| | - Gregory D Trachiotis
- Department of Cardiothoracic Surgery, Veterans Affairs Medical Centre, Washington, DC, USA
| | - John D Puskas
- Department of Cardiovascular Surgery, Mount Sinai Saint Luke's, New York, NY, USA
| | - Stuart J Head
- Department of Cardiothoracic Surgery, Erasmus MC, University Medical Centre, Rotterdam, Netherlands
| |
Collapse
|
2
|
Mao B, Feng Y, Wang W, Li B, Zhao Z, Zhang X, Jin C, Wu D, Liu Y. The influence of hemodynamics on graft patency prediction model based on support vector machine. J Biomech 2019; 98:109426. [PMID: 31677778 DOI: 10.1016/j.jbiomech.2019.109426] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 10/10/2019] [Accepted: 10/13/2019] [Indexed: 01/23/2023]
Abstract
In the existing patency prediction model of coronary artery bypass grafting (CABG), the characteristics are based on graft flow, but no researchers selected hemodynamic factors as the characteristics. The purpose of this paper is to study whether the introduction of hemodynamic factors will affect the performance of the prediction model. Transit time flow-meter (TTFM) waveforms and 1-year postoperative patency results were obtained from 50 internal mammary arterial grafts (LIMA) and 82 saphenous venous grafts (SVG) in 60 patients. Taking TTFM waveforms as the boundary conditions, the CABG ideal models were constructed to obtain hemodynamic factors in grafts. Based on clinical characteristics and combination of clinical and hemodynamic characteristics, patency prediction models based on support vector machine (SVM) were constructed respectively. For LIMA, after the introduction of hemodynamic factors, the accuracy, sensitivity and specificity of the prediction model increased from 70.35%, 50% and 74.17% to 78.02%, 70% and 78.89%, respectively. For SVG, the accuracy, sensitivity and specificity of the prediction model increased from 63.24%, 40% and 76.91% to 74.41%, 60.1% and 82.73%, respectively. The performance of the prediction model can be improved by introducing hemodynamic factors into the characteristics of the model. The accuracy, sensitivity and specificity of the prediction results are higher with the addition of hemodynamic characteristics.
Collapse
Affiliation(s)
- Boyan Mao
- College of Life Science and Bio-Engineering, Beijing University of Technology, No. 100 Pingleyuan, Chaoyang District, Beijing 100124, China
| | - Yue Feng
- College of Life Science and Bio-Engineering, Beijing University of Technology, No. 100 Pingleyuan, Chaoyang District, Beijing 100124, China
| | - Wenxin Wang
- College of Life Science and Bio-Engineering, Beijing University of Technology, No. 100 Pingleyuan, Chaoyang District, Beijing 100124, China; Neusoft Medical System, Neusoft Beijing R&D Center, Zhongguancun Software Park 10, Xibeiwang East Road, Haidian District, Beijing 100194, China
| | - Bao Li
- College of Life Science and Bio-Engineering, Beijing University of Technology, No. 100 Pingleyuan, Chaoyang District, Beijing 100124, China
| | - Zhou Zhao
- Cardiac Surgery Department, PeKing University People's Hospital, 11th South Ave. Xizhimen, Beijing, China
| | - Xiaoyan Zhang
- College of Life Science and Bio-Engineering, Beijing University of Technology, No. 100 Pingleyuan, Chaoyang District, Beijing 100124, China
| | - Chunbo Jin
- College of Life Science and Bio-Engineering, Beijing University of Technology, No. 100 Pingleyuan, Chaoyang District, Beijing 100124, China
| | - Dandan Wu
- College of Life Science and Bio-Engineering, Beijing University of Technology, No. 100 Pingleyuan, Chaoyang District, Beijing 100124, China
| | - Youjun Liu
- College of Life Science and Bio-Engineering, Beijing University of Technology, No. 100 Pingleyuan, Chaoyang District, Beijing 100124, China.
| |
Collapse
|
3
|
Mao B, Wang W, Zhao Z, Zhao X, Li L, Zhang H, Liu Y. On the relationship between competitive flow and FFT analysis of the flow waves in the left internal mammary artery graft in the process of CABG. Biomed Eng Online 2016; 15:129. [PMID: 28155726 PMCID: PMC5259820 DOI: 10.1186/s12938-016-0260-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND During coronary artery bypass grafting (CABG), the ratio of powers of the fundamental frequency and its first harmonic (F0/H1) in fast Fourier transformation (FFT) analysis of the graft's flow waves has been used in the field of evaluation of the patency in anastomosis. But there is no report about using the FFT method to evaluate the magnitude of competitive flow. This study is aiming at exploring the relationship between competitive flow and FFT analysis of the flow waves in left internal mammary artery (LIMA) graft, and finding a new method to evaluate the magnitude of competitive flow. METHODS At first, establishing the CABG multiscale models of different stenosis in left anterior descending artery (LAD) to get different magnitude of competitive flows. Then, calculating the models by ANSYS-CFX and getting the flow waves in LIMA. Finally, analyzing the flow waves by FFT method and comparing the FFT results with the magnitude of competitive flow. RESULTS There is no relationship between competitive flow and F0/H1. As for F0/H2 and F0/H3, they both increase with the reduction of the stenosis in LAD. But the increase of F0/H3 is not obviously enough and it can't identify the significant competitive flow clearly, so it can't be used as the evaluation index. It is found that F0/H2 increases obviously with the increase of the competitive flow and can identify the significant competitive flow. CONCLUSION The FFT method can be used in the evaluation of competitive flow and the F0/H2 is the ideal index. High F0/H2 refers to the significant competitive flow. This method can be used during CABG to avoid the risk of competitive flow.
Collapse
Affiliation(s)
- Boyan Mao
- College of Life Science and Bio-engineering, Beijing University of Technology, Beijing, China
| | - Wenxin Wang
- College of Life Science and Bio-engineering, Beijing University of Technology, Beijing, China
| | - Zhou Zhao
- Peking University People’s Hospital, Beijing, China
| | - Xi Zhao
- College of Life Science and Bio-engineering, Beijing University of Technology, Beijing, China
| | - Lanlan Li
- College of Life Science and Bio-engineering, Beijing University of Technology, Beijing, China
| | - Huixia Zhang
- College of Life Science and Bio-engineering, Beijing University of Technology, Beijing, China
| | - Youjun Liu
- College of Life Science and Bio-engineering, Beijing University of Technology, Beijing, China
| |
Collapse
|
4
|
Hinz J, Mansur A, Hanekop GG, Weyland A, Popov AF, Schmitto JD, Grüne FFG, Bauer M, Kazmaier S. Influence of isoflurane on the diastolic pressure-flow relationship and critical occlusion pressure during arterial CABG surgery: a randomized controlled trial. PeerJ 2016; 4:e1619. [PMID: 26966644 PMCID: PMC4783760 DOI: 10.7717/peerj.1619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Accepted: 01/02/2016] [Indexed: 11/20/2022] Open
Abstract
The effects of isoflurane on the determinants of blood flow during Coronary Artery Bypass Graft (CABG) surgery are not completely understood. This study characterized the influence of isoflurane on the diastolic Pressure-Flow (P-F) relationship and Critical Occlusion Pressure (COP) during CABG surgery. Twenty patients undergoing CABG surgery were studied. Patients were assigned to an isoflurane or control group. Hemodynamic and flow measurements during CABG surgery were performed twice (15 minutes after the discontinuation of extracorporeal circulation (T15) and again 15 minutes later (T30)). The zero flow pressure intercept (a measure of COP) was extrapolated from a linear regression analysis of the instantaneous diastolic P-F relationship. In the isoflurane group, the application of isoflurane significantly increased the slope of the diastolic P-F relationship by 215% indicating a mean reduction of Coronary Vascular Resistance (CVR) by 46%. Simultaneously, the Mean Diastolic Aortic Pressure (MDAP) decreased by 19% mainly due to a decrease in the systemic vascular resistance index by 21%. The COP, cardiac index, heart rate, Left Ventricular End-Diastolic Pressure (LVEDP) and Coronary Sinus Pressure (CSP) did not change significantly. In the control group, the parameters remained unchanged. In both groups, COP significantly exceeded the CSP and LVEDP at both time points. We conclude that short-term application of isoflurane at a sedative concentration markedly increases the slope of the instantaneous diastolic P-F relationship during CABG surgery implying a distinct decrease with CVR in patients undergoing CABG surgery.
Collapse
Affiliation(s)
- José Hinz
- Department of Anesthesiology, University Medical Center Goettingen , Germany
| | - Ashham Mansur
- Department of Anesthesiology, University Medical Center Goettingen , Germany
| | - Gerd G Hanekop
- Department of Anesthesiology, University Medical Center Goettingen , Goettingen , Germany
| | - Andreas Weyland
- Department of Anesthesiology and Intensive Care Medicine, University of Oldenburg , Oldenburg , Germany
| | - Aron F Popov
- Department of Cardiothoracic Surgery, Transplantation & Mechanical Support, Royal Brompton & Harefield Hospital , London , United Kingdom
| | - Jan D Schmitto
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School , Hannover , Germany
| | - Frank F G Grüne
- Department of Anesthesiology, Erasmus University/Rotterdam , Rotterdam , Netherlands
| | - Martin Bauer
- Department of Anesthesiology, University Medical Center Goettingen , Göttingen , Germany
| | - Stephan Kazmaier
- Department of Anesthesiology, University Medical Center Goettingen , Goettingen , Germany
| |
Collapse
|
5
|
Takami Y, Masumoto H. Transit-time flow measurement cannot detect wrong anastomosis of an internal thoracic artery with the cardiac vein in coronary artery surgery. J Thorac Cardiovasc Surg 2004; 128:629-31. [PMID: 15457171 DOI: 10.1016/j.jtcvs.2004.02.032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Affiliation(s)
- Yoshiyuki Takami
- Division of Cardiovascular Surgery, Kasugai Municipal Hospital, Kasugai City, Japan.
| | | |
Collapse
|
6
|
Gwozdziewicz M. CARDIOMED CORONARY FLOW METER FOR PREVENTION OF EARLY OCCLUSION IN AORTOCORONARY BYPASS GRAFTING. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2004; 148:59-61. [PMID: 15523548 DOI: 10.5507/bp.2004.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION The number of patients undergoing technically demanding off-pump myocardial revascularization is increasing, these days. Some researchers question the quality of the aortocoronary bypasses done on the beating heart and consequently their good patency. MATERIAL AND METHODS 50 consecutive patients underwent off pump coronary surgery using sequential bypass technique, at our department. The quality of constructed grafts was evaluated using the CardioMed Trace System (CM4008, Medi-Stim As, Oslo, Norway) (TTFM). RESULTS All sequential bypasses showed good per-operative quality with a mean fl ow of 69.4 ml/min. CONCLUSION TTFM seems to be an effective tool for the per-operative aortocoronary bypass patency verification and should help to prevent early graft occlusion. ABBREVIATIONS TTFM transit time flow meter.
Collapse
Affiliation(s)
- Marek Gwozdziewicz
- Department of Cardiac Surgery, Teaching Hospital, Olomouc, Czech Republic
| |
Collapse
|
7
|
Lee HG, Yum MK. Fourier transformation of arterial Doppler waveforms of the lower extremity. JOURNAL OF CLINICAL ULTRASOUND : JCU 2004; 32:277-285. [PMID: 15211673 DOI: 10.1002/jcu.20040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
PURPOSE Although it is well known that the normal, triphasic pulsatile arterial Doppler waveform changes in shape as flow is impaired, interpretation of the waveform has largely been subjective. We aimed to describe the Doppler waveforms of the lower extremity objectively using Fourier transformation. METHODS Sixty-eight zero-crossing detector arterial recordings from 25 lower extremities were grouped as follows: group 1, no ischemic symptoms with an ankle-brachial index (ABI) > 0.9 (n = 17, 8 limbs); group 2, no ischemic symptoms with ABI < 0.9 (n = 18, 5 limbs); group 3, symptoms of claudication (n = 19, 7 limbs); group 4, rest pain or tissue loss (n = 14, 5 limbs). The waveforms were Fourier transformed and their amplitudes and phases were compared up to the third harmonic (H3). RESULTS Amplitudes of both the fundamental (H1) and second harmonic (H2) were predominant in group 1. In contrast, amplitudes of the H2 and H3 decreased with altered flow (p < 0.0001 for group 1 versus others). The phases of the H1 and H2 were delayed with altered flow (p < 0.05 for group 1 versus others). Phases of the H1 were different between group 2 and 4 (p < 0.05). The difference of phase between the H3 and H1 was shortened with altered flow (p < 0.05 for group 1 or 2 versus group 4). Multivariate analysis revealed that the relative amplitudes of the H2 and H3, the phases of the H1 and H2, and the relative phase of the H3 were significant discriminators among the groups. CONCLUSION Abnormal waveforms could be characterized by the predominant amplitude of the H1, phase delay of the H1 and H2, and shortening of the relative phase of the H3. These parameters may be useful in the evaluation of Doppler waveforms in patients with peripheral arterial disease.
Collapse
Affiliation(s)
- Hong Gi Lee
- Department of Surgery, Hanyang University Kuri Hospital, 249-1 Kyomun-dong, Kuri-si, Kyunggi-do 471-020, South Korea
| | | |
Collapse
|
8
|
Affiliation(s)
- Robert A Lancey
- Bassett Heart Care Institute, Mary Imogene Bassett Hospital, Cooperstown, New York, USA
| |
Collapse
|
9
|
Takami Y, Ina H. Effects of skeletonization on intraoperative flow and anastomosis diameter of internal thoracic arteries in coronary artery bypass grafting. Ann Thorac Surg 2002; 73:1441-5. [PMID: 12022530 DOI: 10.1016/s0003-4975(02)03501-4] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
BACKGROUND We examined the hypothesis that complete skeletonization of an internal thoracic artery (ITA) results in increased diameter of the graft for anastomosis and therefore improves graft flow in coronary artery bypass grafting. METHODS We studied 65 consecutive patients who underwent coronary artery bypass grafting, in which the left ITA was anastomosed to the left anterior descending artery. The first 20 consecutive ITA were harvested as a pedicle (group P) and later 45 consecutive ITAs were harvested as an ultrasonically skeletonized graft (group S). Intraoperative ITA graft mean flows were obtained with a transit-time flowmeter. Three diameters of the ITA graft were measured quantitatively in postoperative angiograms performed 14 +/- 5 days after the coronary artery bypass grafting; D1, at the origin from the subclavian artery; D2, at the level of the second intercostal space; and D3, just proximal to the anastomosis. RESULTS Intraoperative mean flow was significantly greater in group S than in group P (S: 42.6 +/- 29.1 mL/min versus P: 26.4 +/- 16.1 mL/min, p = 0.03). Although the diameters D1 and D2 were not significantly different between groups, D3 was significantly larger in group S than in group p (S: 1.77 +/- 0.28 mm versus P: 1.57 +/- 0.17 mm, p = 0.02). CONCLUSIONS Compared with pedicle harvesting, complete skeletonization of ITA may make it possible to anastomose an ITA with a larger diameter in coronary artery bypass grafting, which leads to increased graft flow by decreasing vascular resistance.
Collapse
Affiliation(s)
- Yoshiyuki Takami
- Division of Cardiovascular Surgery, Kasugai Municipal Hospital, Japan.
| | | |
Collapse
|