Key result
Arterial grafts with pulsatility index ≤3 reduced the odds of requiring an IABP and prolonged ventilation, with similar TTFM and mortality between trainees and the consultant.
Why the study?
Trainees need to operate under supervision to become competent, and this study aimed to compare intra- and postoperative outcomes including TTFM between a consultant and trainees, and examine the relationship between pulsatility index and outcomes.
Does isolated CABG performed by supervised trainees achieve similar intraoperative transit time flow measurements and postoperative outcomes compared to a consultant, and does a graft pulsatility index ≤3 predict better postoperative outcomes?
Cohort (n=155)
No
Does isolated CABG performed by supervised trainees achieve similar intraoperative transit time flow measurements and postoperative outcomes compared to a consultant, and does a graft pulsatility index ≤3 predict better postoperative outcomes?
With appropriate case selection and supervision, cardiothoracic trainees achieve graft flow measurements and postoperative outcomes comparable to a consultant in isolated CABG, while an arterial graft pulsatility index ≤3 is associated with significantly lower odds of IABP requirement and prolonged ventilation.
Answers are grounded in this paper and cite their sources.
Supports supervised trainee CABG; leaves open whether pulsatility index ≤3 warrants routine graft selection in prospective trials.
BACKGROUND: Trainees need to operate under appropriate supervision to become competent. Transit time flow measurement (TTFM) is useful in detecting intraoperative graft failures during coronary artery bypass grafting (CABG). This study aims to compare the intra- and postoperative outcomes, including TTFM, of isolated CABG performed by a single consultant versus trainees and to determine the relationship between the pulsatility index (PI) and postoperative outcomes. METHODS: This retrospective study included 155 isolated CABG cases. Intraoperative outcomes included duration of cardiopulmonary bypass (CPB) and aortic cross-clamp and TTFM for arterial and venous grafts. Postoperative outcomes included common postoperative complications and mortality. The odds ratios of postoperative complications and mortality for arterial and venous grafts with PI ≤3 relative to grafts with PI >3 were determined with multiple logistic regression. RESULTS: The duration of CPB and aortic cross-clamp was significantly shorter in the consultant's group. TTFM for both arterial and venous grafts were similar and no significant differences in postoperative complications and mortality were detected between the two groups. Patients with arterial grafts with PI ≤3 were less likely to require an intra-aortic balloon pump (IABP) or be ventilated for a prolonged period. No significant differences in postoperative outcomes and mortality were detected between venous grafts with PI ≤3 and PI >3. CONCLUSIONS: Trainees can achieve good results in isolated CABG with appropriate case selection. Patients with arterial grafts with PI ≤3 have better postoperative outcomes.
No takes yet. Share an insight, caveat, or question.
Tan et al. (2022) conducted a cohort in Elective isolated coronary artery bypass grafting (CABG) (n=155). Arterial graft pulsatility index (PI) ≤3 on transit time flow measurement (TTFM) (and CABG by trainees vs consultant) vs. Arterial graft pulsatility index (PI) >3 (and CABG performed by consultant) was evaluated on Need for intra-aortic balloon pump (IABP) in patients with arterial graft pulsatility index ≤3 vs >3 (OR 0.259, 95% CI 0.090, 0.743, p=0.012). Arterial grafts with pulsatility index ≤3 reduced the odds of requiring an IABP and prolonged ventilation, with similar TTFM and mortality between trainees and the consultant.
Synapse has enriched 10 related papers. Consider them for comparative context: