Because the goal of coronary artery bypass grafting (CABG) is to restore adequate blood flow to an ischemic area of the myocardium, a successful outcome depends on satisfactory graft function. Over the years, as a consequence of increased surgical experience and improved materials and techniques, the graft patency rate for traditional CABG (using cardiopulmonary bypass) has steadily risen, until it is now in the 90% range. With the advent of beating-heart CABG and minimally invasive approaches, however, anastomotic quality has again become a matter for concern: the operative field is not only limited but may also be in motion, which poses a considerable technical challenge.
Intraoperative Graft Patency Verification in Cardiac and Vascular Surgery is an excellent book that describes techniques for assessing the quality of grafts intraoperatively, on the basis of the presence and volume of flow. Edited by 5 cardiothoracic surgeons from the State University of New York (Buffalo) and the University of Miami, the book consists of 11 chapters and an appendix. The editors helped pioneer the use of transit time flow measurement (TTFM) for the verification of graft patency in CABG, and most of the chapters focus on this assessment method. The book begins by presenting the basic concepts of rheology (chapter 1) and by reviewing intraoperative flowmetry techniques (chapter 2). Next, it introduces the principles and clinical applications of TTFM (chapter 3) and explains this method's use in vascular and general surgery (chapter 4). The book then discusses competitive flow and steal phenomena (chapter 5), as well as the Buffalo experience with TTFM in off-pump CABG (chapter 6, written by the editors). Subsequent chapters deal with formal flow in coronary surgery (chapter 7) and predicting the level of anastomotic stenosis in off-pump CABG (chapter 8). The book then compares coronary angiography with TTFM (chapter 9), discusses the predictive value of intraoperative flow measurements for postoperative angiographic follow-up (chapter 10), and gives a brief history of TTFM (chapter 11). Finally, the appendix presents 14 clinical cases that should help readers apply TTFM in their own practices.
This book is a convenient size and offers a pleasing format. For a multi-authored work, it is unusually consistent in style, tone, and readability. It also includes abundant references and many black-and-white drawings, graphs, and photos. Although not as eye-catching as some of its glossier, more colorful companions on the medical bookshelf, this volume has a great deal to say and says it very well. I recommend it not only as a useful tool for cardiovascular surgeons and cardiologists but also as a handy reference for bioengineers and medical technicians.