FAILED CORONARY-ARTERY BYPASS ANASTOMOSIS DETECTED BY INTRAOPERATIVE CORONARY FLOW MEASUREMENT

Objectives: To assess intraoperative Bow of arterial and venous corona ry grafts after myocardial revascularization which may allow early det ection of low flow situations, especially during minimally invasive co ronary bypass surgery (MIDCAB), and lead to immediate correction of te chnical problems. Methods: In two patients with severe and diffuse mul ti-vessel disease the left internal mammary artery (TMA) was connected to the left anterior descending artery (LAD). During reperfusion, the Bow was measured in the IMA and vein grafts using a transit: lime Row meter. Results: In both cases the IMA showed only a systolic pendulat ing Bow curve with a mean flow of 0-1 ml/min and a high resistance. Ma nual IIA assessment revealed an adequate pulsation. Both distal IMA an astomoses were re-explored on cardiopulmonary bypass yielding an initi al Bow of 7 and 14 ml/min, respectively. After treatment with papaveri ne/adenosine the IMA Row increased from 7 to 26 ml/min (coronary Bow r eserve (CFR)= 3.7) and from 14 to 46 ml/min (CFR = 3.3), respectively. Conclusion: Intraoperative Bow assessment of IMA and venous bypass gr afts can be recommended to monitor flow; especially during MIDCAB proc edures. (C) 1998 Elsevier Science B.V.