D'Ancona G, Karamanoukian H L, Salerno T A, Schmid S, Bergsland J
The Center for Minimally Invasive Cardiac Surgery, Buffalo General Hospital and State University of New York at Buffalo, New York, NY, USA.
Heart Surg Forum. 1999;2(2):121-4.
Many of the modern less invasive approaches to coronary artery bypass grafting (CABG) are performed without the use of the heart lung machine and cardiac asystole. Even after the introduction of mechanical stabilizers, the ability to achieve a technically perfect anastomosis is less certain in beating heart bypass surgery. Our group has begun to assess the surgical results of beating heart CABG using Transit Time Flow Measurement (TTFM). Our experience indicates that a meticulous and controlled method of assessing the results of intraoperative flow measurements can improve the quality of information and increases the accuracy of diagnosing technical problems with newly constructed bypass grafts. For this reason, we developed a standard algorithm for using and interpreting intraoperative TTFM.
From January to August of 1998, 161 patients underwent off-pump CABG with a total of 323 distal anastomoses (2.0 grafts per patient). All completed grafts were tested intraoperatively with TTFM and the decision to accept or revise any individual graft was based on a decision nomogram using key values readily available from the TTFM output.
Thirty-two grafts (9.9%) were surgically revised based on unsatisfactory flow curves, the Pulsatile Index, or both. All revised grafts were found to have a significant technical error, such as an intimal flap, thrombus, conduit kinking, or dissection. There were no major complications, myocardial infarctions, or deaths in the entire series of patients.
Based on our favorable use of TTFM, we strongly recommend that patency of every graft be assessed whether the operation is performed off pump or on cardiopulmonary bypass. Guidelines for performing and interpreting TTFM ensure a high degree of confidence in the completed graft. The decision to revise a graft can be made based on simple parameters easily acquired from the TTFM device. Any concern about quality or quantity of flow should prompt immediate revision.
许多现代冠状动脉旁路移植术（CABG）的微创方法在不使用心肺机和心脏停搏的情况下进行。即使引入了机械稳定器，在心脏跳动的搭桥手术中实现技术上完美的吻合的能力仍不太确定。我们的团队已开始使用渡越时间血流测量（TTFM）评估心脏跳动CABG的手术结果。我们的经验表明，一种细致且可控的术中血流测量结果评估方法可以提高信息质量，并提高诊断新建旁路移植技术问题的准确性。因此，我们开发了一种使用和解释术中TTFM的标准算法。
1998年1月至8月，161例患者接受了非体外循环CABG，共进行了323次远端吻合（每位患者2.0个移植物）。所有完成的移植物均在术中用TTFM进行测试，接受或修改任何单个移植物的决定基于使用从TTFM输出中容易获得的关键值的决策列线图。
32个移植物（9.9%）因血流曲线、搏动指数或两者均不理想而进行了手术修改。所有修改的移植物均发现有重大技术错误，如内膜瓣、血栓、管道扭结或夹层。整个系列患者中无重大并发症、心肌梗死或死亡。
基于我们对TTFM的良好使用，我们强烈建议无论手术是在非体外循环还是体外循环下进行，都应评估每个移植物的通畅情况。进行和解释TTFM的指南确保了对完成的移植物有高度的信心。可以根据从TTFM设备轻松获取的简单参数来决定是否修改移植物。对血流质量或数量的任何担忧都应促使立即修改。
