Table 1:
Studies reporting rates of abnormal grafts and/or revised grafts assessed by TTFM
| Study | Year | Design | Number of grafts/patients | Procedure specificsa | Graft outcome | Reasons for abnormal or revised grafts | Results |
|---|---|---|---|---|---|---|---|
| Hashim et al. [11] | 2017 | Prospective | 86/60 | TTFM on ITA | Abnormal | PI >1.0 with an MGF <20 ml/min in an arrested heart | Not specified |
| Revision | Not specified | 3.5% (n = 3 grafts) | |||||
| Hiraoka et al. [12] | 2017 | Prospective | 104/63 | TTFM on ITA, RA and SVG | Abnormal | PI >5.0 and an MGF <20 ml/min in ITA-graft or <40 ml/min in SVG | 8.7% (n = 9 grafts) |
| Leon et al. [13] | 2017 | Retrospective | 543/177 | TTFM on ITA and SVG | Revision | PI ≥5.0 | 0.9% (n = 5 grafts) |
| Handa et al. [14] | 2016 | Retrospective | 196/68 | OPCAB with TTFM on ITA and SVG | Abnormal | Abnormal TTFM parameters: MGF <15 ml/min, DF <50% and PI >5.0 | 40% (n = 46 grafts) of which 54% appeared patent on postoperative CAG |
| Revision | MGF <5 ml/min or DF <50% or PI >5.0 | 3.0% (n = 6 grafts) | |||||
| Oshima et al. [15] | 2016 | Retrospective | 214/196 | TTFM on ITA and SVG | Abnormal | Lower mean flow (21.3 ± 16.2 ml/min) and higher PI (5.5 ± 4.7) | 7.0% (n = 15 grafts) |
| Honda et al. [16] | 2015 | Retrospective | 72/72 | TTFM on in situ ITA | Abnormal | MGF <20 ml/min and PI = 2.0 | 1.4% (n = 1 graft) |
| Di Giammarco et al. [17] | 2014 | Prospective | 717/333 | TTFM on ITA and SVG | Abnormal | Grafts with MGF ≤15 ml/min and PI ≥3.0 were defined as failing | 5.4% (n = 39 grafts) |
| Revision | Failing grafts based on TTFM and surgical inspection | 0.3% (n = 2 grafts) | |||||
| Quin et al. [18] | 2014 | Retrospective | 2738/1067 | TTFM on ITA, SVG and RA | Abnormal | MGF <20 ml/min | 20.7% (n = 568 grafts) |
| Revision | MGF <20 ml/min and abnormal PI <3.0 (0.7%), 3.0–5.0 (2.9%) and >5.0 (5.8%) | 2.0% (n = 54 grafts) | |||||
| Harahsheh [19] | 2012 | Prospective | 1394/436 | Not specifiedb | Abnormal | MGF <20 ml/min, PI >5.0 and DF <50% | 7.2% (n = 100 grafts) |
| Revision | Not specified | 1.0% (n = 14 grafts) | |||||
| 1.1% (n = 5 patients) | |||||||
| Kuroyanagi et al. [20] | 2012 | Retrospective | 435/159 | OPCAB with TTFM on ITA and SVG | Revision | Cut-off values not specified | 2.0% (n = 9 grafts) |
| Kieser et al. [8] | 2010 | Prospective | 1015/336 | TTFM on ITA, SVG and RA | Abnormal | PI >5.0 | 7% (n = 74 grafts) |
| Revision | PI >5, MGF ≤15 ml/min and DF ≤25 with surgical signs of graft malfunctioning | 18% (n = 59 patients) | |||||
| 2.0% (n = 20 grafts) | |||||||
| 4.2% (n = 14 patients) | |||||||
| Handa et al. [21] | 2009 | Retrospective | 116/39 | OPCAB with TTFM on ITA and SVG | Abnormal | MGF <10 ml/min, PI >5.0 or DF <50% | 2.6% (n = 3 grafts) |
| Revision | MGF = 0 ml/min | 1.7% (n = 2 grafts) | |||||
| Nordgaard et al. [22] | 2009 | Retrospective | 1390/581 | TTFM on ITA and SVG | Revision | Low MGF and high PI | 0.4% (n = 5 grafts) |
| Santarpino et al. [23] | 2009 | Prospective | 238/238 | TTFM on LITA + RA versus LITA + SVG | Revision | TTFM systolic waveform and PI >4.0 based on thrombosis (n = 2) and torsion of the graft (n = 1) | 1.3% (n = 3 grafts) |
| 1.3% (n = 3 patients) | |||||||
| Waseda et al. [24] | 2009 | Retrospective | 289/116 | TTFM on ITA, SVG, RA and GEA | Abnormal | MGF ≤5 ml/min and PI >5 | 7.3% (n = 21 grafts) |
| Revision | Failing grafts on IFI, yet acceptable TTFM (MGF >5 ml/min and PI ≤5) results | 2.1% (n = 6 grafts) | |||||
| Herman et al. [25] | 2008 | Prospective | …/985 | TTFM on ITA and SVG | Abnormal | PI >5 | 18.7% (n = 184 patients) |
| Revision | Anastomotic (n = 9), conduit (n = 8), subclavian stenosis (n = 1) and unidentified (n = 2) | 2.0% (n = 20 patients) | |||||
| Onorati et al. [26] | 2008 | Retrospective | …/433 | TTFM on ITA and RA | Abnormal | PI >5 and low MGF (not specified) | 0.2% (n = 1 patients) |
| Revision | MGF ≤3 ml/min and PI ≥5 | 0.7% (n = 3 patients) | |||||
| Becit et al. [27] | 2007 | Retrospective | 303/200 | TTFM versus without TTFM on ITA, SVG or RA | Revision | Unsatisfactory TTFM parameters due to kinked/twisted grafts (n = 4) or stenosis in proximal LITA (n = 2) or poor native coronary vessel (n = 3) | 3.0% (n = 9 grafts) |
| 9.0% (n = 9 patients) | |||||||
| Mujanovic et al. [28] | 2007 | Prospective | 2872/1000 | Not specifiedb | Revision | Cut-off values not specified | 2.2% (n = 64 grafts) |
| 6.3% (n = 63 patients) | |||||||
| Onorati et al. [29] | 2007 | RCT | 90/90 | TTFM on single-SVG versus sequential-SVG | Abnormal | PI >5 and low MGF (not specified) | 5.6% (n = 5 grafts) |
| Revision | ‘Systolic’ pattern of the curve with low MGF (4 ml/min) and high PI (7.8)” | 5.6% (n = 5 patients) | |||||
| 1.1% (n = 1 graft) | |||||||
| 1.1% (n = 1 patient) | |||||||
| Desai et al. [30] | 2006 | RCT | 139/106 | TTFM and IFI on ITA, SVG and RA | Abnormal | DF <50%, PI >5.0 and MGF <10 ml/min | 2.6% (n = 3 grafts) |
| Revision | MGF = 0 ml/min | 1.4% (n = 2 grafts) | |||||
| Poston et al. [31] | 2006 | Prospective | 410/410 | TTFM on SVG | Revision | MGF <10 ml/min | 0.5% (n = 2 grafts) |
| Balacumaraswami et al. [32] | 2005 | Prospective | 266/100 | TTFM on ITA and RA | Abnormal | Not specified | 9.4% (n = 25 grafts) |
| Revision | Persistent poor MGF with TTFM and IFI under adequate MAP (>80 mmHg) | 25.0% (n = 25 patients) | |||||
| 3.0% (n = 8 grafts) | |||||||
| 8.0% (n = 8 patients) | |||||||
| Kim et al. [33] | 2005 | Retrospective | 117/58 | OPCAB with TTFM on ITA, RA and GEA | Abnormal | Low MGF <3 ml/min or high PI (>20.0) | 12.0% (n = 14 grafts) |
| Leong et al. [34] | 2005 | Prospective | 322/116 | TTFM on ITA and SVG | Revision | Low MGF, high PI and unsatisfactory flow curve (values not specified) due to occluded, stretched, kinked/twisted grafts or anastomotic stenosis | 2.2% (n = 7 grafts) |
| 5.2% (n = 6 patients) | |||||||
| Onorati et al. [35] | 2005 | Prospective | …/297 | TTFM on ITA and RA | Abnormal | Low MGF and high PI, without systolic peak pattern on the flow curves | 2.4% (n = 7 patients) |
| Revision | Systolic wave-pattern, low MGF (9 ml/min) and high PI | 0.3% (n = 1 patient) | |||||
| Bergsland et al. [36] | 2004 | Prospective | 113/46 | OPCAB with TTFM on ITA and SVG | Revision | Abnormal MGF in 5 grafts due to distal anastomosis problems (n = 3), long grafts (n = 1) and vein graft stenosis (n = 1) | 4.4% (n = 5 grafts) |
| Gwozdziewicz [37] | 2004 | Prospective | …/50 | OPCAB with TTFM on ITA and SVG | Revision | Grafts with low MGF and high PI (>5) | 0.0% (n = 0 grafts) |
| 0.0% (n = 0 patients) | |||||||
| Guden et al. [38] | 2003 | RCT | …/300 | TTFM on ITA | Revision | MGF close to 0 ml/min and PI >5.0, due to intimal flaps and localized dissections at anastomosis site | 1.3% (n = 4 grafts) |
| Sanisoglu et al. [39] | 2003 | Prospective | 49/20 | OPCAB with TTFM on ITA and SVG | Revision | Graft failure based on low MGF (5.2 ml/min) and high PI (11.9) | 5.0% (n = 1 grafts) |
| 2.0% (n = 1 patients) | |||||||
| Groom et al. [40] | 2001 | Prospective | 298/125 | TTFM in ITA and SVG | Revision | Low MGF and/or high PI (not specified) | 3.0% (n = 9 grafts) |
| 7.2% (n = 9 patients) | |||||||
| D’Ancona et al. [41] | 2000 | Prospective | 1145/409 | OPCAB with TTFM on ITA and SVG | Revision | Abnormal systolic flow patterns, PI >5.0 and low MGF due to (i) kinking, (ii) coronary dissection or (iii) thrombosis/stenosis at the anastomosis site | 3.5% (n = 41 grafts) |
| 7.9% (n = 33 patients) | |||||||
| Jakobsen and Kjaergard [42] | 1999 | Prospective | …/280 | TTFM on ITA and SVG | Abnormal | MGF <10 ml/min due to kinking, rotation or occlusion | 1.8% (n = 5 grafts) |
| Walpoth et al. [43] | 1998 | Prospective | 46/46 | TTFM on ITA | Abnormal | Low-flow through ITA-graft (<0.5 ± 0.7 ml/min), high PI (147 ± 96) and elevated vascular resistance | 6.5% (n = 3 grafts) 6.5% (n = 3 patients) |
| Revision | 1 distal ITA dissection, 1 ITA intramural haematoma and 1 abnormal ECG and poor LV-anterior wall contractility | 6.5% (n = 3 grafts) 6.5% (n = 3 patients) | |||||
| Canver and Dame [44] | 1994 | Prospective | …/63 | TTFM on ITA | Abnormal | Absence of ITA flow due to twisting at the anastomosis site | 3.2% (n = 2 patients) |
Results are presented as percentages with the number of grafts and (if available) by the number of patients.
a
On-pump unless specified.
b
No specification on which grafts were assessed by TTFM.
CAG: coronary angiography; DF: diastolic filling; ECG: electrocardiogram; GEA: gastroepiploic artery; HR-ECUS: high-resolution-epicardial ultrasonography; IFI: intraoperative fluorescence imaging; ITA: internal thoracic artery; LITA: left internal thoracic artery; LV: left ventricular; MAP: mean arterial pressure; MGF: mean graft flow; OPCAB: off-pump coronary artery bypass; PI: pulsatility index; RA: radial artery; RCT: randomized controlled trial; SVG: saphenous vein graft; TTFM: transit-time flow measurement.