Intra-operative quality assessment of coronary artery bypass grafts

Early coronary artery bypass graft (CABG) failure is a troubling complicati on that may result in a wide range of problems, including refractory angina , myocardial infarction, low cardiac output, arrhythmia, and fatal heart fa ilure. Early graft failures are related to poor quality and size of the dis tal native vascular bed, coagulation abnormalities, or technical problems i nvolving the graft conduits and anastomoses. Unfortunately, graft failure i s difficult to detect during surgery by visual assessment, palpation, or co nventional monitoring. We evaluated the accuracy and utility of a transit-t ime, ultrasonic flow measurement system for measurement of CABGs. There wer e no differences between transit-time measurements and volumetric-time coll ected samples In an in vitro circuit over a range of flows from 10 to 100 m l/min (Bland and Altman Plot, 1.96 SD). Two hundred and ninety-eight CABGs were examined In 125 patients. Graft flow rate was proportional to the target vessel diameter. Nine techni cal errors were detected and corrected. Flow waveform morphology provided v aluable information related to the quality of the anastamosis, which led to the immediate correction of technical problems at the time of surgery.