Analysis of a multicenter registry on evaluation of transit-time flow in coronary artery disease surgeryCentral MessagePerspective
Mojgan Laali, MD, PhD,
Olivier Bouchot, MD, PhD,
Olivier Fouquet, MD, PhD,
Pablo Maureira, MD, PhD,
Jean-Philippe Verhoye, MD, PhD,
Pierre Corbi, MD, PhD,
Charles-Henri David, MD, PhD,
Cosimo D'Alessandro, MD,
Pierre Demondion, MD,
Guillaume Lebreton, MD, PhD,
Pascal Leprince, MD, PhD
Affiliations
Mojgan Laali, MD, PhD
Thoracic and Cardiovascular Surgery Department, Sorbonne Université, APHP, Groupe hospitalier Pitié-Salpétrière, Institute of Cardiology, Paris, France; Address for reprints: Mojgan Laali, MD, PhD, Division of Thoracic and Cardiovascular Surgery, Hôpital La Pitié-Salpêtrière, 47-83 Blvd de l’Hôpital, 75 651 Paris Cedex 13, France.
Olivier Bouchot, MD, PhD
Cardio-Thoracic and Vascular Surgery Unit, Hospital Center University, Dijon, France
Olivier Fouquet, MD, PhD
Cardiac Surgery, Angers University Hospital Center, Angers, France
Pablo Maureira, MD, PhD
Cardiac Surgery Unit, Hospital Center, University de Nancy, Nancy, France
Jean-Philippe Verhoye, MD, PhD
Thoracic and Cardiovascular Surgery Department, Hospital Center, University Rennes, Rennes, France
Pierre Corbi, MD, PhD
Cardio-Thoracic and Vascular Surgery Unit, Hospital Center, University Poitiers, Poitiers, France
Charles-Henri David, MD, PhD
Cardio-Thoracic and Vascular Surgery Unit, CHU Nantes, Nantes, France
Cosimo D'Alessandro, MD
Thoracic and Cardiovascular Surgery Department, Sorbonne Université, APHP, Groupe hospitalier Pitié-Salpétrière, Institute of Cardiology, Paris, France
Pierre Demondion, MD
Thoracic and Cardiovascular Surgery Department, Sorbonne Université, APHP, Groupe hospitalier Pitié-Salpétrière, Institute of Cardiology, Paris, France
Guillaume Lebreton, MD, PhD
Thoracic and Cardiovascular Surgery Department, Sorbonne Université, APHP, Groupe hospitalier Pitié-Salpétrière, Institute of Cardiology, Paris, France
Pascal Leprince, MD, PhD
Thoracic and Cardiovascular Surgery Department, Sorbonne Université, APHP, Groupe hospitalier Pitié-Salpétrière, Institute of Cardiology, Paris, France
Objective: The Evaluation of Transit-Time Flow in Coronary Artery Disease Surgery (EFCAD) registry aims to assess the influence of transit-time flow measurement (TTFM) in daily practice. Methods: EFCAD is a prospective, multicenter study involving 9 centers performing TTFM during isolated coronary artery bypass grafting. Primary end point was occurrence and risk factors of major adverse cardiac events, including perioperative myocardial infarction, urgent postoperative coronary angiogram and/or revascularization, and hospital mortality. Secondary end points were rate of graft revision during surgery and factors affecting graft flow. We respected the limit values set by the experts: mean graft flow >15 mL/minute and pulsatility index ≤5. Results: Between May 2017 and March 2021, 1616 patients were registered in the EFCAD database. After review, 1414 were included for analyses. Of those, 1176 were eligible for primary end point analysis. Graft revision, mainly due to inadequate TTFM values, occurred in 2% (29 patients). The primary end point occurred in 46 (3.9%) patients, and it was related with left anterior descending artery graft flow ≤15 mL/minute (odds ratio, 3.64; P 0 indicates higher flow), and graft origin (aorta vs Y, β = 9.2; in situ left internal thoracic artery vs Y, β = 3.2; in situ right internal thoracic artery vs Y, β = 2.3; P < .001). Conclusions: Data from EFCAD study suggest that TTFM is reliable to evaluate graft flow, and acceptance of inadequate flow on left anterior descending artery anastomosis influence postoperative outcomes. In our opinion, TTFM assessment should be routinely used in coronary artery bypass procedures, even if interpretation depends on learning curves.
