Intraoperative Quality Control in the Coronary Artery Bypass Grafting

Introduction: The issue of the quality of bypass grafts, which appeared to be a key fact in the coronary artery bypass grafting (CABG), was raised with the popularization of the operations performed without the use of cardiopulmonary bypass (CPB). Among handful methods used in the past that were abundant in defects, Transit time flow measurement (TTFM) has recently stood out for its good features. The objective of the paper is: to compare main peri and postoperative results of operations with and without CPB; to establish total number of the bypass grafts revised on the basis of TTFM results in both groups of the examinees; to evaluate sensitivity, specificity, predictive rate and accuracy of TTFM with regards to the intraoperative coronary angiography (golden standard).

Methods: Study was done in the period between 01.07.2002 and 30.06.2004 in two centers. In the Cardiovascular Clinic, University Clinical Centre Tuzla, 150 examinees were operated on without the use of CPB (group A) and compared with 150 examinees operated on with the use of CPB (group B). Main peri and postoperative results and bypass grafts revised on the basis of TTFM findings were analyzed. In the Interventional Center, Rikshospitalet, Oslo, 70 examinees underwent CABG without the use of CPB. The TTFM result of these examinees was compared with the intraoperative angiography result for each bypass graft. THE

Results: Time spent on the respirator was significantly less in the examinees who underwent CABG without the use of CPB (p=0.001) as well as the amount of compensated blood (p=0.034) and the hospitalization duration (p=0.004). The frequency of the bypass grafts revisions based on the TTFM results was higher in the group A but with no statistical importance when compared with the group B (p=0.657). Comparative analysis of the TTFM grades and intraoperative angiographies grades indicated that TTFM has sensitivity 0.953, specificity 1.000, positive predictive rate 1.000, negative predictive rate 0.743, and accuracy 0.958 in relation to the intraoperative anglography.

Conclusion: TTFM is a valid method for intraoperative quality control of coronary artery bypass grafts. Intraoperative quality control would not just improve the operative results, but also the cost-effectiveness of CABG.