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Failed coronary artery bypass anastomosis detected by intraoperative coronary flow measurement

Walpoth, Beat H. ; Bosshard, Andreas ; Kipfer, Beat ; Berdat, Pascal A. ; Ueli, Althaus ; Carrel, Thierry

In: European Journal of Cardio-Thoracic Surgery, 1998, vol. 14, no. Supplement_1, p. S76-S81

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    Titre
    • Failed coronary artery bypass anastomosis detected by intraoperative coronary flow measurement
    Auteur
    • Walpoth, Beat H.. Clinic for Thoracic and Cardiovascular Surgery, University of Berne, Berne, Switzerland
    • Bosshard, Andreas. Clinic for Thoracic and Cardiovascular Surgery, University of Berne, Berne, Switzerland
    • Kipfer, Beat. Clinic for Thoracic and Cardiovascular Surgery, University of Berne, Berne, Switzerland
    • Berdat, Pascal A.. Clinic for Thoracic and Cardiovascular Surgery, University of Berne, Berne, Switzerland
    • Ueli, Althaus. Clinic for Thoracic and Cardiovascular Surgery, University of Berne, Berne, Switzerland
    • Carrel, Thierry. Clinic for Thoracic and Cardiovascular Surgery, University of Berne, Berne, Switzerland
    Type de document
    • Postprint
    Langue
    • Anglais
    Publié dans
    • European Journal of Cardio-Thoracic Surgery, 1998, vol. 14, no. Supplement_1, p. S76-S81. Elsevier Science B.V.
    Autre version électronique
    Identifiant OAI-PMH
    • oai:doc.rero.ch:301778
    Summary
    Objectives: To assess intraoperative flow of arterial and venous coronary grafts after myocardial revascularization which may allow early detection of low flow situations, especially during minimally invasive coronary bypass surgery (MIDCAB), and lead to immediate correction of technical problems. Methods: In two patients with severe and diffuse multi-vessel disease the left internal mammary artery (IMA) was connected to the left anterior descending artery (LAD). During reperfusion, the flow was measured in the IMA and vein grafts using a transit time flow meter. Results: In both cases the IMA showed only a systolic pendulating flow curve with a mean flow of 0-1 ml/min and a high resistance. Manual IMA assessment revealed an adequate pulsation. Both distal IMA anastomoses were re-explored on cardiopulmonary bypass yielding an initial flow of 7 and 14 ml/min, respectively. After treatment with papaverine/adenosine the IMA flow increased from 7 to 26 ml/min (coronary flow reserve (CFR)=3.7) and from 14 to 46 ml/min (CFR=3.3), respectively. Conclusion: Intraoperative flow assessment of IMA and venous bypass grafts can be recommended to monitor flow; especially during MIDCAB procedures