CARDIOVASCULAR JOURNAL OF AFRICA • Volume 34, No 4, September/October 2023 242 AFRICA Comparison of flowmeter (transit time flow measurement) values for graft flow in three different surgical methods for isolated coronary artery bypass surgery Ferhat Borulu, Ümit Arslan, Eyüpserhat Çalik, Bilgehan Erkut Abstract Background: Graft patency is the most important factor in coronary artery bypass surgery. This study aimed to compare the relationship between three different surgical methods and transit time flow measurement (TTFM), which is used to detect technical problems in anastomoses performed during coronary artery bypass graft operations and to correct them if necessary. Methods: A total of 110 patients undergoing isolated coronary artery bypass surgery were analysed. Of these patients, 48 were operated on by inducing cardiopulmonary arrest (group 1), 33 were operated on without inducing cardiac arrest (group 2) during cardiopulmonary bypass surgery, and 29 underwent surgery on the off-pump beating heart (group 3). TTFMs were performed on all the patients’ grafts. Additional surgical intervention requirements, the need for intra-operative and postoperative inotropic support, and all postoperative follow-up data were compared. Results: In total, 110 patients were measured for 301 grafts. Due to insufficient measurements performed on these patients, additional surgical intervention was performed on five grafts in group 1, five grafts in group 2, and seven grafts in group 3. These interventions enabled a normal flow rate to be achieved. The number of grafts that required revision was highest in group 3. There was no difference between the groups in terms of demographic data, EuroSCORE II, preoperative ejection fraction, postoperative complications and mortality rate. Conclusion: TTFM is important for detecting technical problems in grafts. We believe that all surgical methods can be applied more safely by controlling graft flow. Keywords: transit time flow meter, coronary artery bypass surgery Submitted 19/7/20; accepted 21/5/23 Published online 4/7/23 Cardiovasc J Afr 2023; 34: 242–247 www.cvja.co.za DOI: 10.5830/CVJA-2023-029 Grafting with sufficient flow is one of the most important parameters in coronary artery bypass surgery. The absence of sufficient flow in the graft after a recently performed anastomosis can lead to significant increases in mortality rate by causing new infarctions during the procedure and reducing its benefits. Serious increases in mortality and morbidity rates can occur due to early graft failure in the postoperative period.1,2 If the flow problems that arise due to surgical techniques are detected and corrected with necessary interventions, the success of the procedure and the benefits patients can receive from surgery will increase. Nonetheless, research about which surgical methods are more beneficial in terms of anastomosis quality has remained controversial for years. This study aimed to compare anastomoses performed with three different methods during coronary artery bypass surgery with objective parameters that included transit time flow measurement (TTFM). Methods This study included patients who had undergone isolated coronary artery bypass surgery by the same surgical team at the Cardiovascular Surgery Clinic of Atatürk University Faculty of Medicine between August 2017 and March 2019. The study was approved by the local ethics committee, and the patients were retrospectively analysed. At least 48 of these patients were operated on under cardiopulmonary bypass (CPB) by inducing cardiac arrest, 33 were operated on under CPB without inducing cardiac arrest, and 29 underwent off-pump beating heart without CPB. The grafts in all patients were checked bymeasuring transit time flow at the end of the operations. Necessary graft revisions were performed for patients with problems in flow. All interventions and measurements were recorded. All the patients’ demographic data, EuroSCORE II data, operative data, and postoperative follow-up parameters were compared between the three groups. TTFM is an effective method for intra-operatively evaluating graft patency. Although different series disagree about the sensitivity and specificity of TTFM,3,4 European myocardial revascularisation guidelines recommend using this method to control graft openings (Class I recommendation, level of evidence C).5,6 The device (TTFM) is compliant with the European Medical Device Directive 93/42/EEC and is also approved by the US Food and Drug Administration (FDA) [FDA 510(k) cleared no. K102595 and FDA 510(k) cleared no. K040228]. The technique was developed to evaluate graft quality and to measure the blood flow through the graft with its special probe. The device our clinic used was the MediStim VQ-1101, MediStim ASA (Oslo, Norway). The measurements were performed after the anastomoses were completed for all grafts, and cardiac haemodynamic stabilisation was achieved in the Cardiovascular Surgery Department, Faculty of Medicine, Ordu University, Ordu, Turkey Ferhat Borulu, MD, fborulu@gmail.com Cardivascular Surgery Department, Faculty of Medicine, Atatürk University, Erzurum, Turkey Ümit Arslan, MD Eyüpserhat Çalik, MD Bilgehan Erkut, MD
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