Coronary Artery Disease, Coronary Bypass Graft Stenosis, Coronary Stenosis
Conditions
Keywords
coronary artery bypass, Transit Time Flowmetry, Intraoperative epicardial high-frequency ultrasound (HFUS), Coronary anastomosis patency
Brief summary
Transit-time flowmetry (TTFM) allows grafts quality control during coronary artery bypass surgery by measuring the flow volume through them. To date, many studies have deeply studied the predictive role on the graft outcomes of the various flowmetry-derived parameters. One of the least investigated aspects, however, is the mutual influence that two newly realized grafts can have. This possibility would be related to the presence of a more or less developed collateral circulation between the bypassed territories. The purpose of this study is to assess whether a graft for a territory different than that provided by the left anterior descending artery (LAD) may affect the functionality (measured through flowmetry) of the left internal mammary artery - LAD graft.
Interventions
None listed
Sponsors
Fondazione Policlinico Universitario Agostino Gemelli IRCCS
Study design
Observational model
COHORT
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
Yes
Inclusion criteria
* age \> 18 years; * informed consent acquired and registered; * patients who undergo coronary artery bypass grafting (with or without cardiopulmonary bypass); * patients with stable angina, unstable angina or acute coronary syndrome without elevation of the ST tract (NSTEMI)
Exclusion criteria
* patients unable to give informed consent; * patients undergoing emergency surgery; * patients in unstable haemodynamic conditions or in need of pharmacological or mechanical support; * patients undergoing combined surgery; * patients undergoing single aortocoronary bypass surgery
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| LIMA>LAD Pulsatility index (PI) modification | During the surgery, out of cardiopulmonary bypass | The primary aim of this study is to assess whether a graft for a non-LAD coronary target modifies the performance (measured by flowmetry) of the flow in the LIMA\>LAD graft. PI is expressed by the ratio of the flow volume amplitude and mean flow volume, both quantified by a flowmeter (ml/min / ml/min). An ideal value would be < 3 |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| LIMA>LAD mean flow change | During surgery, before and after transient occlusion of the other grafts for non-LAD coronary targets | under rest conditions and after pharmacological stress. The unit of measure will be ml/min. The average flow should be above 20 ml/min. |
| LIMA>LAD Diastolic filling (%DF) change | During surgery,before and after transient occlusion of the other grafts for non-LAD coronary targets. | under rest conditions and after pharmacological stress. The unit of measure will be the ratio between two parameters expressed by ml/min. |
| variation of Diastolic filling (%DF) on the right coronary | During surgery,before and after transient occlusion of the other grafts for non-LAD coronary targets. | depending on its dominance or hyperdominance. The unit of measure will be the ratio between two parameters expressed by ml/min. DF% is accepted around 50%. |
| LIMA>LAD % Backward flow (BF) change | During surgery, before and after transient occlusion of the other grafts for non-LAD coronary targets. | under rest conditions and after pharmacological stress. The unit of measure will be the ratio between two parameters expressed by ml/min. The identified cut-off is 3% of the total flow. |
| mean flow, Pulsatility Index, Diastolic filling (%DF) and Diastolic filling (%DF) in the non-LAD grafts | During surgery, before and after transient occlusion of the LIMA>LAD graft | under rest conditions and after pharmacological stress. The meaf low will be measured in ml/min. The others will be expressed by the ratio between two parameters expressed by ml/min. |
Countries
Italy
Contacts
Primary Contactcammertoni federico
Backup Contactserena davino
Outcome results
None listed