• Takemi Handa, Kazumasa Orihashi, Hideaki Nishimori, Takashi Fukutomi, Masaki Yamamoto, Nobuo Kondo, and Miwa Tashiro.
• Department of Surgery 2, Kochi University, Nankoku, Japan takemi@mpd.biglobe.ne.jp.
• Interact Cardiovasc Thorac Surg. 2015 Apr 1;20(4):449-57.

ObjectivesMaximal graft flow acceleration (max df/dt) determined by transit-time flowmetry (TTFM) in the diastolic phase was assessed as a possible predictor of graft failure in coronary artery bypass patients.MethodsMax df/dt was retrospectively measured in 57 in situ left internal thoracic artery grafts. TTFM data were fitted to a 5-polynomial curve, which was derived from the first-derivative curve to measure max df/dt (5-polymial max df/dt). Abnormal TTFM was defined as a mean flow of <15 ml/min, pulsatility index of >5 or diastolic filling ratio of <50%. Postoperative coronary angiography (CAG) or multidetector computed tomography (MDCT) was performed within 1 year after surgery. The grafts were classified into four groups: Normal TTFM/Patent MDCT/CAG (N/P), Normal TTFM/Failing MDCT/CAG (N/F), Abnormal TTFM/Patent MDCT/CAG (Ab-N/P) and Abnormal TTFM/Failing MDCT/CAG graft (Ab-N/F).ResultsBy TTFM, 34 grafts were normal, 5 of which were occluded on CAG, and 23 grafts were abnormal, six of which were occluded on CAG. There were significant differences in 5-polynomial max df/dt between each group pair (P < 0.05, Mann-Whitney U-test) except for the N/F:Ab-N/P group pair; especially, 5-polynomial max df/dt was significantly lower in the Ab-N/F group compared with the other groups (Ab-N/F: 0.89 ± 0.41 vs N/P: 4.74 ± 3.18, N/F: 2.23 ± 0.65, Ab-N/P: 2.70 ± 1.31 ml/s(2), P < 0.01, Mann-Whitney U-test). The sensitivity and specificity of 5-polynomial max df/dt were, respectively, 72.7 and 80.4% (cut-off value, 1.918 ml/s(2)) for all grafts and 100 and 88.2% (cut-off value, 1.273 ml/s(2)) for abnormal TTFM grafts.ConclusionsThe TTFM 5-polymial max df/dt value in the early diastolic phase may be a promising predictor of future graft failure.© The Author 2015. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

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