Transit time flow measurement and outcome in coronary artery bypass grafting for surgeon and trainee

• Main Authors: Tan, Pheng Hian, Azmi, Muhammad Ibrahim, Zulkifli, Zhafri, Amin, Mohd Afiq, Hassan, Syed Nasir Syed, Zulkifli, Mohd Faizal Effendi, Hashim, Shahrul Amry
• Format: Article
• Published: AME Publishing Company 2022
• Subjects: R Medicine; RA Public aspects of medicine; RD Surgery
• Online Access: http://eprints.um.edu.my/33667/
• Institution: Universiti Malaya

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.