Transit time flow measurement of coronary bypass grafts before and after protamine administration.
Coronary artery bypass grafting
Intraoperative graft flow measurement
Quality control
Journal
Journal of cardiothoracic surgery
ISSN: 1749-8090
Titre abrégé: J Cardiothorac Surg
Pays: England
ID NLM: 101265113
Informations de publication
Date de publication:
09 Jul 2021
09 Jul 2021
Historique:
received:
16
04
2021
accepted:
29
06
2021
entrez:
10
7
2021
pubmed:
11
7
2021
medline:
20
7
2021
Statut:
epublish
Résumé
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. 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. 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. 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. Clinical Trials Number: NCT02385344 , registered February 17th, 2015.
Sections du résumé
BACKGROUND
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
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
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
CONCLUSIONS
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
BACKGROUND
Clinical Trials Number: NCT02385344 , registered February 17th, 2015.
Identifiants
pubmed: 34243799
doi: 10.1186/s13019-021-01575-y
pii: 10.1186/s13019-021-01575-y
pmc: PMC8268198
doi:
Substances chimiques
Heparin Antagonists
0
Protamines
0
Banques de données
ClinicalTrials.gov
['NCT02385344']
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
195Subventions
Organisme : NCATS NIH HHS
ID : UL1 TR001863
Pays : United States
Informations de copyright
© 2021. The Author(s).
Références
Ann Thorac Surg. 2016 May;101(5):1996-2006
pubmed: 26876343
J Thorac Cardiovasc Surg. 2005 Mar;129(3):496-503
pubmed: 15746730
Eur J Cardiothorac Surg. 2019 Jul 1;56(1):64-71
pubmed: 30715312
J Thorac Cardiovasc Surg. 2010 Feb;139(2):294-301, 301.e1
pubmed: 20006356
J Thorac Cardiovasc Surg. 2008 Mar;135(3):533-9
pubmed: 18329465
Heart Vessels. 2008 Sep;23(5):316-24
pubmed: 18810580
Sci Rep. 2020 Jul 31;10(1):12968
pubmed: 32737380
Am J Clin Pathol. 1987 Feb;87(2):210-7
pubmed: 3812352
Int J Cardiol. 2010 Aug 20;143(2):158-64
pubmed: 19264367
Perfusion. 1997 Mar;12(2):99-106
pubmed: 9160360
Eur J Cardiothorac Surg. 2019 Jan 1;55(1):4-90
pubmed: 30165632
J Thorac Cardiovasc Surg. 2020 Apr;159(4):1283-1292.e2
pubmed: 31685277
Eur J Cardiothorac Surg. 1997 Dec;12(6):847-52
pubmed: 9489868
Circulation. 2014 Oct 21;130(17):1445-51
pubmed: 25261549
J Thorac Cardiovasc Surg. 2006 Sep;132(3):468-74
pubmed: 16935097
J Biomech. 2020 Jan 2;98:109426
pubmed: 31677778
Semin Thorac Cardiovasc Surg. 2009 Fall;21(3):207-12
pubmed: 19942118
Eur J Cardiothorac Surg. 2010 Aug;38(2):155-62
pubmed: 20176493
Eur J Cardiothorac Surg. 2014 Mar;45(3):e41-5
pubmed: 24335472
J Thorac Cardiovasc Surg. 1982 Oct;84(4):505-14
pubmed: 7121041
J Cardiovasc Med (Hagerstown). 2017 May;18(5):295-304
pubmed: 27366820