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Open Access 01-12-2021 | CABG | Research article

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

Authors: Dror B. Leviner, Miriam von Mücke Similon, Carlo Maria Rosati, Andrea Amabile, Daniel J. F. M. Thuijs, Gabriele Di Giammarco, Daniel Wendt, Gregory D. Trachiotis, Teresa M. Kieser, A. Pieter Kappetein, Stuart J. Head, David P. Taggart, John D. Puskas

Published in: Journal of Cardiothoracic Surgery | Issue 1/2021

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.

Available only for authorised users

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Title: Transit time flow measurement of coronary bypass grafts before and after protamine administration
Authors: Dror B. Leviner
Miriam von Mücke Similon
Carlo Maria Rosati
Andrea Amabile
Daniel J. F. M. Thuijs
Gabriele Di Giammarco
Daniel Wendt
Gregory D. Trachiotis
Teresa M. Kieser
A. Pieter Kappetein
Stuart J. Head
David P. Taggart
John D. Puskas
Publication date: 01-12-2021
Publisher: BioMed Central
Keywords: CABG
CABG
Published in: Journal of Cardiothoracic Surgery / Issue 1/2021
Electronic ISSN: 1749-8090
DOI: https://doi.org/10.1186/s13019-021-01575-y

At a glance: The STEP trials

Springer Medicine

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

Abstract

Background

Methods

Results

Conclusion

Trial registration

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

Trial registration

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