Document Detail


Can visual assessment of flow waveform morphology detect anastomotic error in off-pump coronary artery bypass grafting?
MedLine Citation:
PMID:  9860203     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: Flow probes are being used for intraoperative assessment of anastomotic quality during off-pump coronary artery bypass grafting (CABG). We conducted a survey with the cooperation of 19 international surgeons to assess the ability of surgeons to detect anastomotic errors by evaluating mean flow and flow waveform morphology. MATERIAL AND METHODS: Mongrel dogs underwent mammary to left anterior descending (LAD) grafting. Mean graft flow and flow wave morphology for varying degrees of anastomotic stenoses were recorded using transit-time flow probes. A questionnaire consisting of ten different recorded flow tracings and the corresponding mean flows were given to 20 surgeons from around the world. The surgeons were asked to determine the degree of stenosis and whether they would re-do the anastomosis based upon the mean flow and the flow tracings. RESULTS: All of the 19 surgeons that responded were able to clearly identify a highly stenotic graft (>90% stenosis). However, 24% would re-do a fully patent anastomosis, 58% accepted an anastomosis with moderate stenosis, and 72% accepted anastomoses with severe stenosis. CONCLUSIONS: Evaluation of flow tracing morphology and/or mean flows can be used to reliably detect nearly occluded anastomoses (>90% stenosis). However, surgeons should be cautious in assessing anastomoses with lesser degrees of stenosis, as they may be more difficult to reliably interpret.
Authors:
S F Jaber; S C Koenig; B BhaskerRao; D J VanHimbergen; P A Spence
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery     Volume:  14     ISSN:  1010-7940     ISO Abbreviation:  Eur J Cardiothorac Surg     Publication Date:  1998 Nov 
Date Detail:
Created Date:  1999-02-25     Completed Date:  1999-02-25     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  8804069     Medline TA:  Eur J Cardiothorac Surg     Country:  NETHERLANDS    
Other Details:
Languages:  eng     Pagination:  476-9     Citation Subset:  IM    
Affiliation:
Jewish Hospital Cardiothoracic Surgical Research Institute, Department of Surgery, University of Louisville, KY 40202, USA.
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MeSH Terms
Descriptor/Qualifier:
Anastomosis, Surgical / adverse effects
Animals
Blood Flow Velocity / physiology
Coronary Artery Bypass* / methods
Coronary Circulation / physiology*
Coronary Disease / diagnosis*
Dogs
Intraoperative Complications / diagnosis*
Monitoring, Intraoperative
Rheology / instrumentation

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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