Transit time flow measurement of coronary bypass grafts before and after protamine administration
Abstract Background Intraoperative graft assessment with tools like Transit Time Flow Measurement (TTFM) is imperative for quality control in coronary surgery. We investigated the variation of TTFM parameters before and after protamine administration to identify new benchmark parameters for graft qu...
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doaj-846bb2fce89146f98ef68fb3cce592662021-07-11T11:41:57ZengBMCJournal of Cardiothoracic Surgery1749-80902021-07-011611910.1186/s13019-021-01575-yTransit time flow measurement of coronary bypass grafts before and after protamine administrationDror B. Leviner0Miriam von Mücke Similon1Carlo Maria Rosati2Andrea Amabile3Daniel J. F. M. Thuijs4Gabriele Di Giammarco5Daniel Wendt6Gregory D. Trachiotis7Teresa M. Kieser8A. Pieter Kappetein9Stuart J. Head10David P. Taggart11John D. Puskas12Department of cardiac surgery, Carmel Medical CenterSackler School of Medicine New York State/American Program, Tel Aviv UniversityDepartment of Cardiovascular Surgery, Mount Sinai MorningsideDepartment of Cardiovascular Surgery, Mount Sinai MorningsideDepartment of Cardiothoracic Surgery, Erasmus MC, University Medical CenterClinica Cardiochirurgica, Università “G.D’Annunzio”Department of Thoracic and Cardiovascular Surgery, West German Heart CenterHeart center, Veterans Affairs Medical CenterLIBIN Cardiovascular Institute of AlbertaDepartment of Cardiothoracic Surgery, Erasmus MC, University Medical CenterDepartment of Cardiothoracic Surgery, Erasmus MC, University Medical CenterDepartment of Cardiovascular Surgery, University of OxfordDepartment of Cardiovascular Surgery, Mount Sinai MorningsideAbstract Background Intraoperative graft assessment with tools like Transit Time Flow Measurement (TTFM) is imperative for quality control in coronary surgery. We investigated the variation of TTFM parameters before and after protamine administration to identify new benchmark parameters for graft quality assessment. Methods The database of the REQUEST (“REgistry for QUality AssESsmenT with Ultrasound Imaging and TTFM in Cardiac Bypass Surgery”) study was retrospectively reviewed. A per graft analysis was performed. Only single grafts (i.e., no sequential nor composite grafts) where both pre- and post-protamine TTFM values were recorded with an acoustical coupling index > 30% were included. Grafts with incomplete data and mixed grafts (arterio-venous) were excluded. A second analysis was performed including single grafts only in the same MAP range pre- and post- protamine administration. Results After adjusting for MAP, we found a small increase in MGF (29 mL/min to 30 mL/min, p = 0.009) and decrease in PI (2.3 to 2.2, p < 0.001) were observed after the administration of protamine. These changes were especially notable for venous conduits and for CABG procedures performed on-pump. Conclusion The small changes in TTFM parameters observed before and after protamine administration seem to be clinically irrelevant, despite being statistically significant in aggregate. Our data do not support a need to perform TTFM measurements both before and after protamine administration. A single TTFM measurement taken either before or after protamine may suffice to achieve reliable data on each graft’s performance. Depending on the specific clinical situation and intraoperative changes, more measurements may be informative. Trial registration Clinical Trials Number: NCT02385344 , registered February 17th, 2015.https://doi.org/10.1186/s13019-021-01575-yCoronary artery bypass graftingQuality controlIntraoperative graft flow measurement |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Dror B. Leviner Miriam von Mücke Similon Carlo Maria Rosati Andrea Amabile Daniel J. F. M. Thuijs Gabriele Di Giammarco Daniel Wendt Gregory D. Trachiotis Teresa M. Kieser A. Pieter Kappetein Stuart J. Head David P. Taggart John D. Puskas |
spellingShingle |
Dror B. Leviner Miriam von Mücke Similon Carlo Maria Rosati Andrea Amabile Daniel J. F. M. Thuijs Gabriele Di Giammarco Daniel Wendt Gregory D. Trachiotis Teresa M. Kieser A. Pieter Kappetein Stuart J. Head David P. Taggart John D. Puskas Transit time flow measurement of coronary bypass grafts before and after protamine administration Journal of Cardiothoracic Surgery Coronary artery bypass grafting Quality control Intraoperative graft flow measurement |
author_facet |
Dror B. Leviner Miriam von Mücke Similon Carlo Maria Rosati Andrea Amabile Daniel J. F. M. Thuijs Gabriele Di Giammarco Daniel Wendt Gregory D. Trachiotis Teresa M. Kieser A. Pieter Kappetein Stuart J. Head David P. Taggart John D. Puskas |
author_sort |
Dror B. Leviner |
title |
Transit time flow measurement of coronary bypass grafts before and after protamine administration |
title_short |
Transit time flow measurement of coronary bypass grafts before and after protamine administration |
title_full |
Transit time flow measurement of coronary bypass grafts before and after protamine administration |
title_fullStr |
Transit time flow measurement of coronary bypass grafts before and after protamine administration |
title_full_unstemmed |
Transit time flow measurement of coronary bypass grafts before and after protamine administration |
title_sort |
transit time flow measurement of coronary bypass grafts before and after protamine administration |
publisher |
BMC |
series |
Journal of Cardiothoracic Surgery |
issn |
1749-8090 |
publishDate |
2021-07-01 |
description |
Abstract Background Intraoperative graft assessment with tools like Transit Time Flow Measurement (TTFM) is imperative for quality control in coronary surgery. We investigated the variation of TTFM parameters before and after protamine administration to identify new benchmark parameters for graft quality assessment. Methods The database of the REQUEST (“REgistry for QUality AssESsmenT with Ultrasound Imaging and TTFM in Cardiac Bypass Surgery”) study was retrospectively reviewed. A per graft analysis was performed. Only single grafts (i.e., no sequential nor composite grafts) where both pre- and post-protamine TTFM values were recorded with an acoustical coupling index > 30% were included. Grafts with incomplete data and mixed grafts (arterio-venous) were excluded. A second analysis was performed including single grafts only in the same MAP range pre- and post- protamine administration. Results After adjusting for MAP, we found a small increase in MGF (29 mL/min to 30 mL/min, p = 0.009) and decrease in PI (2.3 to 2.2, p < 0.001) were observed after the administration of protamine. These changes were especially notable for venous conduits and for CABG procedures performed on-pump. Conclusion The small changes in TTFM parameters observed before and after protamine administration seem to be clinically irrelevant, despite being statistically significant in aggregate. Our data do not support a need to perform TTFM measurements both before and after protamine administration. A single TTFM measurement taken either before or after protamine may suffice to achieve reliable data on each graft’s performance. Depending on the specific clinical situation and intraoperative changes, more measurements may be informative. Trial registration Clinical Trials Number: NCT02385344 , registered February 17th, 2015. |
topic |
Coronary artery bypass grafting Quality control Intraoperative graft flow measurement |
url |
https://doi.org/10.1186/s13019-021-01575-y |
work_keys_str_mv |
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