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J Thorac Cardiovasc Surg 2003;126:645-650
© 2003 The American Association for Thoracic Surgery

Cardiopulmonary support and physiology

Transit time flow measurement in on-pump and off-pump coronary artery surgery

^a Department of Cardiac Surgery,^a Heart Center University of Bonn, Bonn, Germany
^b Institute for Medical Biometry, Informatics, and Epidemiology,^b Bonn, Germany

Received for publication April 25, 2002; revisions received June 24, 2002; revisions received August 27, 2002; accepted for publication September 11, 2002.

^* Address for reprints: Christoph Schmitz, MD, Department of Cardiac Surgery, University of Bonn, Sigmund-Freud-Strasse 25, 53105, Bonn, Germany
c.schmitz{at}uni-bonn.de

OBJECTIVE:: Transit time flow measurement is frequently used during coronary artery bypass with and without cardiopulmonary bypass to detect graft dysfunction resulting from technical errors.

METHODS: Intraoperative transit time flow measurement measurements of 896 patients requiring surgery for double- or triple-vessel disease were reviewed retrospectively. Six-hundred and ninety-five patients were operated on-pump (Group A: coronary artery bypass with cardiopulmonary bypass), and 201 patients off-pump (Group B: coronary artery bypass without cardiopulmonary bypass). Transit time flow measurement measurements were analyzed for mean flow (mL/min). In total, measurements of 2247 grafts were analyzed.

RESULTS: Transit time flow measurement flows were lower in coronary artery bypass without cardiopulmonary bypass patients (left internal thoracic artery to left anterior descending artery: Group A, 37 [31, 40] mL/min vs Group B, 24 [20, 26] mL/min; saphenous vein graft to left anterior descending artery: Group A, 46.5 [40, 56] mL/min vs Group B, 21 [14, 57] mL/min. Troponin I release was reduced in the coronary artery bypass without cardiopulmonary bypass patients, with median values of 7.8 [7.0, 8.3] µg/L in Group A and 1.2 [0.9, 2.3] µg/L in Group B.

CONCLUSION: Evaluation of transit time flow measurement is valuable in determining coronary graft patency after coronary artery bypass with cardiopulmonary bypass and coronary artery bypass without cardiopulmonary bypass. Decreased troponin I release suggests a myocardial benefit of coronary artery bypass without cardiopulmonary bypass compared to coronary artery bypass with cardiopulmonary bypass, although the intraoperative transit time flow measurement flow measurements are markedly lower.

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