Transit time flow measurement of coronary bypass grafts before and after protamine administration.

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  • Additional Information
    • Source:
      Publisher: BioMed Central Country of Publication: England NLM ID: 101265113 Publication Model: Electronic Cited Medium: Internet ISSN: 1749-8090 (Electronic) Linking ISSN: 17498090 NLM ISO Abbreviation: J Cardiothorac Surg Subsets: MEDLINE
    • Publication Information:
      Original Publication: [London] : BioMed Central, 2006-
    • Subject Terms:
      Coronary Artery Bypass* ; Coronary Circulation*; Heparin Antagonists/*therapeutic use ; Protamines/*therapeutic use; Adult ; Aged ; Aged, 80 and over ; Blood Flow Velocity ; Female ; Humans ; Male ; Middle Aged ; Registries ; Retrospective Studies ; Vascular Patency
    • Abstract:
      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: 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: 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: 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: Clinical Trials Number: NCT02385344 , registered February 17th, 2015.
      (© 2021. The Author(s).)
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    • Grant Information:
      UL1 TR001863 United States TR NCATS NIH HHS
    • Contributed Indexing:
      Keywords: Coronary artery bypass grafting; Intraoperative graft flow measurement; Quality control
    • Molecular Sequence:
      ClinicalTrials.gov NCT02385344
    • Accession Number:
      0 (Heparin Antagonists)
      0 (Protamines)
    • Publication Date:
      Date Created: 20210710 Date Completed: 20210719 Latest Revision: 20220327
    • Publication Date:
      20221213
    • Accession Number:
      PMC8268198
    • Accession Number:
      10.1186/s13019-021-01575-y
    • Accession Number:
      34243799