Scientific Online Resource System

Scripta Scientifica Medica

Transit-time flowmetric evaluation of coronary artery bypass graft flow after off- and on-pump myocardial revascularization

Vladimir Kornovski, Plamen Panayotov, Atanas Angelov, Tsvetan Gradinarov


Introduction: Incorrect performance of anastomoses to the target coronary arteries often causes coronary artery disease and patient`s death following myocardial revascularization. Coronary graft patency evaluation is obligatory for prevention of peri- and postoperative myocardial ischemia.

Aim: The objective of the present study was to comparatively assess the values of mean coronary flow and pulsatility index in arterial and venous grafts in patients after on-pump- and off-pump myocardial revascularization.

Materials and Methods: During the period between January 1, 2014 and December 31, 2017, 143 coronary artery disease patients, 111 males at a mean age of 63.29±9.78 years and 32 females at a mean age of 66.43±9.58 years were operated on in the Department of Cardiac Surgery, St. Marina University Hospital of Varna. Myocardial revascularization was performed by using 92 arterial and 65 venous coronary grafts in the on-pump group (ONCAB) and 137 arterial and 45 venous grafts in the off-pump group (OPCAB). Coronary graft blood flow was assessed by means of coronary angiography and transit-time flowmetry (TTFM).

Results: There were different values of the mean coronary flow and pulsatility index (PI) in arterial and venous conduits, both intervention types, as well as in males and females. The difference between male and female patients in terms of the mean values of venous grafts is statistically reliable (χ2=11.410; р≤0.022 and r=-0.310; p=0.001). The PI values in arterial grafts differed statistically significantly between both intervention types (p=0.003). Much more revisions of arterial and venous conduits on the occasion of insufficient patency were performed in the ONCAP than in the OPCAB group.

Conclusion: Based on our results and literature data available, we could recommend the wide application of the method of TTFM for exact recognition of the circulatory disorders in the coronary graft following CAGB in Bulgaria.


coronary artery bypass grafting, intraoperative transit time flowmetry, coronary angiography, coronary blood flow assessment, graft revision

Full Text


Lobo HG Filho, Lobo JG Filho, Pimentel MD, Silva BG, Souza CS, Montenegro ML, et al. Intraoperative analysis of flow dynamics in arteriovenous composite Y grafts. Braz J Cardiovasc Surg. 2016;31(5):351-7. doi: 10.5935/1678-9741.20160053.

Leon M, Stanham R, Soca G, Dayan V. Do flow and pulsatility index within the accepted ranges predict long-term outcomes after coronary artery bypass grafting? Thorac Cardiovasc Surg. 2017 Apr 12. doi: 10.1055/s-0037-1600116.

Di Giammarco G, Marinelli D, Foschi M, Di Mauro M. Intraoperative graft verification in coronary surgery. J Cardiovasc Med (Hagerstown). 2017;18(5):295-304. doi: 10.2459/JCM.0000000000000401.

Niclauss L. Techniques and standards in intraoperative graft verification by transit time flow measurement after coronary artery bypass graft surgery: a critical review. Eur J Cardiothorac Surg. 2017;51(1):26-33. doi: 10.1093/ejcts/ezw203.

Takami Y, Takagi Y. Roles of transit-time flow measurement for coronary artery bypass surgery. Thorac Cardiovasc Surg. 2018 Jan 19. doi: 10.1055/s-0037-1618575.

Ohmes LB, Di Franco A, Di Giammarco G, Rosati CM, Lau C, Girardi LN, et al. Techniques for intraoperative graft assessment in coronary artery bypass surgery. J Thorac Dis. 2017;9(Suppl 4):S327-S32. doi: 10.21037/jtd.2017.03.77.

Hultgren K, Andreasson A, Axelsson TA, Albertsson P, Lepore V, Jeppsson A. Acute coronary angiography after coronary artery bypass grafting. Scand Cardiovasc J. 2016;50(2):123-7. doi: 10.3109/14017431.2016.1143112.

Szavits-Nossan J, Stipić H, Sesto I, Kapov-Svilicić K, Sipić T, Bernat R. Angiographic control and percutaneous treatment of myocardial ischemia immediately after CABG. Coll Antropol. 2012;36(4):1391-4.

Kassimis G, Krasopoulos G. False positive transit time flowmetry graft failure in multivessel coronary spasm following off-pump coronary artery bypass grafting. Case Rep Cardiol. 2017;2017:3186047. doi: 10.1155/2017/3186047.

Oshima H, Tokuda Y, Araki Y, Ishii H, Murohara T, Ozaki Y, et al. Predictors of early graft failure after coronary artery bypass grafting for chronic total occlusion. Interact Cardiovasc Thorac Surg. 2016;23(1):142-9. doi: 10.1093/icvts/ivw084.

Amin S, Pinho-Gomes AC, Taggart DP. Relationship of intraoperative transit time flowmetry findings to angiographic graft patency at follow-up. Ann Thorac Surg. 2016;101(5):1996-2006. doi: 10.1016/j.athoracsur.2015.10.101.

Amin S, Werner RS, Madsen PL, Krasopoulos G, Taggart DP. Intraoperative bypass graft flow measurement with transit time flowmetry: a clinical assessment. Ann Thorac Surg. 2018;106(2):532-8. doi: 10.1016/j.athoracsur.2018.02.067.

Amin S, Werner RS, Madsen PL, Krasopoulos G, Taggart DP. Influence of coronary territory on flow profiles of saphenous vein grafts. J Cardiothorac Surg. 2018a;13(1):23. doi: 10.1186/s13019-018-0709-6.

Bazylev VV, Nemchenko EV, RosseÄ­kin EV, Mikuliak AI. Flowmetric and angiographic predictors of occlusion of coronary bypass grafts. Angiol Sosud Khir. 2018;24(2):49-55 (in Russian).

Kaya U, Çolak A, Becit N, Ceviz M, Koçak H. Intraoperative transit-time flow measurement in on-pump coronary artery bypass graft surgery: Single center experience. Turk J Thorac Cardiovasc Surg. 2018;26(2):167-76.

Nakajima H, Iguchi A, Tabata M, Kambe M, Ikeda M, Uwabe K, et al. Preserved autoregulation of coronary flow after off-pump coronary artery bypass grafting: retrospective assessment of intraoperative transit time flowmetry with and without intra-aortic balloon counterpulsation. J Cardiothorac Surg. 2016;11(1):156. doi: 10.1186/s13019-016-0550-8.

Handa T, Orihashi K, Nishimori H, Yamamoto M. Maximal blood flow acceleration analysis in the early diastolic phase for aortocoronary artery bypass grafts: a new transit-time flow measurement predictor of graft failure following coronary artery bypass grafting. Surg Today. 2016;46(11):1325-33. doi: 10.1007/s00595-016-1325-5.

Biancari F, Anttila V, Dell'Aquila AM, Airaksinen JKE, Brascia D. Control angiography for perioperative myocardial Ischemia after coronary surgery: Meta-analysis. J Cardiothorac Surg. 2018;13(1): 24. doi: 10.1186/s13019-018-0710-0.

Preußer MJ, Landwehrt J, Mastrobuoni S, Biancari F, Dakkak AR, Alshakaki M, et al. Survival results of postoperative coronary angiogram for treatment of perioperative myocardial ischaemia following coronary artery bypass grafting: a single-centre experience. Interact Cardiovasc Thorac Surg. 2018;26(2):237-42. doi: 10.1093/icvts/ivx317.

Fleißner F, Issam I, Martens A, Cebotari S, Haverich A, Shrestha ML. The unplanned postoperative coronary angiogram after CABG: Identifying the patients at risk. Thorac Cardiovasc Surg. 2017;65(4):292-5. doi: 10.1055/s-0035-1564927.



About The Authors

Vladimir Kornovski
St. Marina University Hospital of Varna

Department of Cardiac Surgery

Plamen Panayotov
St. Marina University Hospital of Varna

Department of Cardiac Surgery

Atanas Angelov
St. Marina University Hospital of Varna

First Department of Internal Medicine

Tsvetan Gradinarov
St. Marina University Hospital of Varna

Department of Anesthesiology, Emergency and Intensive Medicine

Font Size