Abdurakhmanov Abdusalom, Buranov Shahboz, Mamataliev Farkhod, Tursunov Saidjalol, Obeid Mustapha, Ganiev Ulugbek
Republican Research Center of Emergency Medicine, Tashkent, Uzbekistan.
Bukhara Branch of Republican Research Center of Emergency Medicine, Bukhara, Uzbekistan.
J Cardiovasc Thorac Res. 2025 Jun 28;17(2):128-132. doi: 10.34172/jcvtr.025.33244. eCollection 2025 Jun.
Intraoperative transit time flowmetry (TTF) is an essential technique for evaluating graft function during off-pump coronary artery bypass grafting (OPCABG). This study compares graft quality and outcomes using TTF in two surgical approaches: sequential and Y-type saphenous vein grafting.
A total of 120 patients with triple-vessel coronary artery disease were enrolled and randomized into two groups: Group 1 (n=60) received sequential grafts; Group 2 (n=60) received Y-grafts. Mean graft flow (MGF) and pulsatility index (PI) were measured intraoperatively. Graft function was classified based on flow>15 ml/min and PI<2.5. All patients underwent coronary CT angiography at 48 months to assess graft patency.
Intraoperative TTF showed no significant difference in MGF or PI between graft types, although sequential grafts demonstrated slightly higher flow and lower resistance. Intraoperative graft failure occurred in 1.7% (sequential) vs. 3.3% (Y-grafts). At 48-month follow-up, sequential grafts showed 100% patency, while Y-grafts had a 7.0% occlusion rate. Multivariate analysis identified vessel diameter and conduit type as significant predictors of graft performance; graft configuration (sequential vs. Y) was not independently predictive.
TTF is a valuable intraoperative tool for ensuring graft functionality in OPCABG. While both techniques are viable, sequential grafting demonstrated superior mid-term patency and lower failure rates. These findings support the preferential use of sequential grafting when anatomically feasible and highlight the importance of routine TTF to optimize surgical outcomes.
术中通过时间血流测定法（TTF）是在非体外循环冠状动脉旁路移植术（OPCABG）期间评估移植物功能的一项重要技术。本研究比较了在两种手术方式（序贯式和Y型大隐静脉移植）中使用TTF时的移植物质量和结果。
总共纳入120例三支血管冠状动脉疾病患者，并随机分为两组：第1组（n = 60）接受序贯移植物；第2组（n = 60）接受Y型移植物。术中测量平均移植物血流（MGF）和搏动指数（PI）。根据血流>15 ml/min和PI<2.5对移植物功能进行分类。所有患者在48个月时接受冠状动脉CT血管造影以评估移植物通畅情况。
术中TTF显示，尽管序贯移植物的血流略高且阻力较低，但不同类型移植物之间的MGF或PI无显著差异。术中移植物失败发生率在序贯移植物组为1.7%，在Y型移植物组为3.3%。在48个月的随访中，序贯移植物显示100%通畅，而Y型移植物的闭塞率为7.0%。多变量分析确定血管直径和管道类型是移植物性能的重要预测因素；移植物构型（序贯式与Y型）并非独立预测因素。
TTF是确保OPCABG中移植物功能的一种有价值的术中工具。虽然两种技术都是可行的，但序贯移植显示出更好的中期通畅率和更低的失败率。这些发现支持在解剖学可行时优先使用序贯移植，并强调常规TTF对优化手术结果的重要性。
