Does the Presence of an External Stent Affect Intraoperative Transit Time Flowmetry Parameters in Coronary Bypass Artery Bypass Surgery
Sanaz Amin, Jr.1, Raphael S. Werner2, George Krasopoulos1, David P. Taggart1.
1University of Oxford, Oxford, United Kingdom, 2University of Zurich, Zurich, Switzerland.
OBJECTIVE: Coronary Artery Bypass Grafting (CABG) remains the gold standard treatment for multi-vessel coronary artery disease. Despite well-documented benefits of multiple arterial grafts, autologous saphenous vein grafts (SVGs) remain the most widely used bypass conduits in CABG and, in fact, their use appears to be increasing. Recent clinical studies have demonstrated that external stenting of SVGs significantly reduce diffuse intimal hyperplasia by improving lumen uniformity and haemodynamic flow patterns.The aim of this study is to assess Transit Time Flowmetry (TTFM) parameters (MGF; mean graft flow, PI; pulsatility index, %DF; diastolic filling and %BF; backward flow) in stented versus non-stented vein grafts.
METHODS: This study is part of a multicentre, randomised, self-controlled clinical study (VEST III). A total of thirty-five patients from one centre alone were included in this study. Each patient received one external stent device to a single SVG, randomly assigned intraoperatively, to either the right or the left coronary territory. One or more SVG remained non-stented and served as the control group. The primary end-point was assessment of MGF, PI, %DF and %BF by TTFM in stented versus non-stented SVGs to the left and the right coronary territory.All flow measurements were carried out with the VeriQC device (Medistim ASA, Oslo, Norway).
RESULTS:Please see attachement.
CONCLUSIONS:External stenting of saphenous vein grafts do not affect intraoperative flow parameters.Previous study, VEST II, showed no significant difference in TTFM parameters in stented-patent vs. stented-occluded grafts at 1-year angiographic follow up. Previous studies have further demonstrated that external stenting of SVGs significantly reduce diffuse intimal hyperplasia by improving lumen uniformity and haemodynamic flow patterns.As such, external stenting of saphenous vein grafts do not affect intraoperative flow parameters or harm the vessels in coronary bypass surgery but further results from randomised clinical studies await.
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