Role of coronary graft flow measurement during reoperations for early graft failure after off-pump coronary revascularization

Doppler-based techniques of coronary graft flow measurement are frequently used, especially during coronary artery bypass grafting (CABG) without card iopulmonary bypass (CPB), to exclude graft dysfunction resulting from techn ical errors. Nevertheless, early graft failure in the immediate postoperati ve period continues to affect a small percentage of patients who may requir e emergent reoperation as a result of severe hemodynamic deterioration. In this setting, in which coronary angiography is infrequently an option, expe ditious intraoperative assessment of previously constructed coronary grafts may be performed by using the Doppler-based technique Transit Time Flow Me asurement (TTFM). As a result, the hemodynamic values obtained during reope rations may guide the operative strategy. In this study we report on eight patients who underwent "off-pump" CABG and necessitated early reinterventio n as a result of presumed graft dysfunction. In these patients, graft dysfu nction was confirmed or excluded by using intraoperatively the TTFM techniq ue, comparing newly obtained flow hemodynamic variables with those recorded as a baseline during primary operations.