The procedure for intraoperative graft verification in coronary surgery: Is high resolution epicardial imaging useful in addition to Transit-Time flow measurement to reduce postoperative failures?
© Di Giammarco et al. 2015
Published: 16 December 2015
Transit-Time Flow Measurement (TTFM) is a valid method of intraoperative graft verification. TTFM shows a low diagnostic accuracy due to high number of false positive.
High-Resolution Epicardial Ultrasonography (HR-ECUS) is a well-recognized procedure for coronary anastomosis and stenosis evaluation with high sensitivity and specificity.
The aim of the study is to verify if the combined use of TTFM and HR-ECUS in intraoperative graft verification process can increase the diagnostic accuracy of procedure itself.
From November 2009 to December 2014, 741 patients underwent isolated CABG. A total number of 1733 grafts were performed; all the grafts were intraoperatively verified by means of both TTFM and HR-ECUS.
Among all grafts considered functioning at TTFM, 7 (0.4%) were failing at HR-ECUS and promptly redone. These were confirmed as true positive at graft revision due to technical error. HR-ECUS confirmed the good functioning of the remaining grafts already demonstrated by TTFM; among them, 8 showed high troponin I release (clinical false negative), whereas the remaining had no high TnI release (clinical true negative). In 2 of 39 grafts malfunctioning at TTFM, HR-ECUS confirmed the graft failure. Finally, in 35 cases, HR-ECUS did not confirm TTFM diagnosis demonstrating a full patency of the anastomosis; these grafts had an uneventful clinical course (true negative). The main result of this study is the increase of PPV from 10% with TTFM to almost 100% of TTFM + HR-ECUS, avoiding many unnecessary graft revisions.
In intraoperative graft verification procedure the combined use of TTFM and HR-ECUS increase diagnostic accuracy of the verification process close to 100%. Both methods should be used intraoperatively in order to achieve the best outcome for the patient.
This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.