Key result
Left-sided SVGs show ~5% higher diastolic filling than right-sided grafts.
Why the study?
Differing perfusion of the left and right ventricular coronary territory may influence flow profiles of saphenous vein grafts during CABG.
Does anastomosing saphenous vein grafts to the left versus right coronary territory influence intraoperative transit-time flowmetry parameters in CABG patients?
Observational (n=207)
No
Does anastomosing saphenous vein grafts to the left versus right coronary territory influence intraoperative transit-time flowmetry parameters in CABG patients?
Mean Difference: 5.1 (95% CI 2.86–7.34)
Absolute Event Rate: 63.3% vs 58.1%
p-value: p=<0.001
Although statistically significant differences exist in diastolic filling between left- and right-sided saphenous vein grafts, these differences are small and unlikely to be clinically relevant for intraoperative graft assessment.
Small TTFM differences by territory appear clinically insignificant; leaves open whether territory-specific norms enhance graft assessment in prospective studies.
BACKGROUND: Differing perfusion of the left and right ventricular coronary territory may influence flow-profiles of saphenous vein grafts (SVGs). We compared flow parameters, measured by transit-time flowmetry (TTFM), in left- and right-sided SVGs during coronary artery by-pass grafting (CABG). METHODS: Routine TTFM measurements were obtained in 167 SVGs to the left territory (55%) and 134 SVGs to the right territory (total of 301 SVGs in 207 patients). The four standard TTFM parameters, [mean graft flow (MGF), pulsatility index (PI), percentage diastolic filling (%DF), and percentage backward flow (%BF)] were compared. Differences in flow parameters were also examined according to surgical technique (on- vs. off-pump). RESULTS: No significant difference between coronary territories was found for MGF, PI and %BF. However, a higher %DF was noted in left-sided SVGs in the overall cohort as well as in the on-pump (both p < 0.001) and the off-pump cohorts (p = 0.07). Further, a significantly higher %BF was found in SVGs performed off-pump to the left territory (1.2 ± 2.5 vs. 2.3 ± 3.0, p = 0.023). In a multivariate regression analysis, anastomosing a SVG to the left territory was weakly associated with higher PI (OR = 0.36, p = 0.026) and strongly associated with higher %DF (OR = 5.1, p < 0.001). No significant association was found for MGF, PI, %DF or %BF in either the on-pump nor the off-pump cohorts. CONCLUSIONS: Although statistically significant, the established differences in TTFM parameters between left- and right-sided vein grafts were small and unlikely to be of clinical relevance.
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Amin et al. (2018) conducted an observational in Coronary artery disease (n=207). Grafting to the left coronary territory vs. Grafting to the right coronary territory was evaluated on Percentage diastolic filling (%DF) (MD 5.1, 95% CI 2.86-7.34, p=<0.001). Saphenous vein grafts anastomosed to the left coronary territory demonstrated a significantly higher percentage of diastolic filling compared to right-sided grafts, though the difference was small.
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