Dai Une
   Department   Kawasaki Medical School  Kawasaki Medical School, Department of Cardiovascular Surgery,
   Position   Professor
Article types 原著
Language English
Peer review Peer reviewed
Title Cut-off values for transit time flowmetry: are the revision criteria appropriate?
Journal Formal name：Journal of cardiac surgery
Abbreviation：J Card Surg
ISSN code：15408191/08860440
Domestic / ForeginForegin
Volume, Issue, Page 28(1),pp.3-7
Author and coauthor Dai Une, Saswata Deb, Genta Chikazawa, Kamya Kommaraju, Hiroshi Tsuneyoshi, Reena Karkhanis, Steve Singh, Jessica Vincent, Hideki Tsubota, Jeri Sever, Fuad Moussa, Gideon Cohen, George T Christakis, Stephen E Fremes
Publication date 2013/01
Summary BACKGROUND:Graft Imaging to Improve Patency (GRIIP), a single-center, randomized blinded clinical trial, reported that intraoperative graft assessment with graft revision according to a priori criteria of transit time flowmetry (TTF) and intraoperative fluorescent angiography did not improve graft patency at one year after coronary artery bypass grafting (CABG) when compared with standard intraoperative management. The objective of this study is to investigate whether other TTF values are more predictive of the saphenous vein graft (SVG) failure and/or clinical outcomes.METHODS:This is a case control retrospective study of 65 SVGs from 44 patients from GRIIP. Study outcomes were graft patency at 12 months and major adverse cardiac events (MACE; death, myocardial infarction, repeat revascularization).RESULTS:Twenty-two SVGs were occluded. In receiver operating characteristic curve analysis, TTF mean flow was significantly predictive of one-year SVG failure (area under the curve = 0.698, p < 0.01), and 31 mL/min was the best cut-off value (p = 0.017, sensitivity 63.6%, specificity 67.4%). The risk of graft occlusion was 14/28, 50% for grafts with mean flow <31 mL/min and 8/37, 21.6% for grafts with mean flow ≥ 31 mL/min. In logistic regression models, mean flow was a significant predictor of early SVG failure (Odds Ratio 0.95 [0.91-0.99] per mL/min, p = 0.014) whereas other TTF values, patient comorbidities, and/or medication at discharge were not. However, TTF values were not predictive of MACE.CONCLUSIONS:TTF can identify non-functional grafts during CABG, but is of questionable value to improve one-year graft patency.
DOI 10.1111/jocs.12036
PMID 23189982