Intraoperative graft failure is a well-recognized issue with a rate of 4–5% of incidence involving the 10% of patient submitted to CABG.Despite this evidence and the recommendation of international guidelines the routine use of intraoperative graft verification is low.The purpose of this multicentric prospective international registry was to assess the impact of routine use of Transit-Time Flow Measurement (TTFM) and High-Resolution Epicardial Ultrasonography (HR-ECUS) in CABG patients.
The design of the study imposed to enroll 1000 patients in 7 centers (Italy,UK,USA,Canada,Germany,Netherlands) from 2015 to 2017.The inclusion criterium was the indication to isolated CABG operation in patient with at least 2-vessel disease.The study protocol and ethical approval was published in clinicaltrial.gov in February, 2015. The endpoints of the registry were: 1)any change in planned surgical procedure;2)type of change (aorta,coronary target, conduits,anastomosis);3)number and reason for the revision;4)in-hospital mortality and stroke.
total of 346 surgical strategy changes were registered in 249 (26%) patients.HR-ECUS leads to change in aorta manipulation sites in 10% of the patients,in coronary anastomotic site in 20% of the patients and the combined use of TTFM and HR-ECUS to 3% of intraoperative graft revision.The total number of adverse events was 1017 (22% mild,70% moderate,8% severe.The mortality rate was 0.5% with a stroke rate of 0.7%.
In the hands of expert surgeons,high rate of optimal medical therapy use (> 70%) and state-of-the-art surgical procedure the intraoperative guidance and graft verification of HR-ECUS and TTFM were associated with a 3% of revision rate and low-level of in-hospital mortality and stroke.
1Istituto di Cardiochirurgia-Dipartimento di neuroscienze, imaging e scienze cliniche- Università “G. D’Annunzio” Chieti-Pescara Chieti
2Oxford University Oxford, UK
3Mount Sinay St. Luke's New York, USA
4University of Essen Essen, Germany
5University of Calgary Calgary, Canada
6George Washington University Washington, USA
7Erasmus MC Rotterdam, Netherlands