OBJECTIVES We evaluated graft patency by computed tomography and explored the determinants of intraoperative mean graft flow (MGF) and its contribution to predict early graft occlusion. METHODS One hundred and forty-eight patients under a single surgeon were prospectively enrolled. Arterial and endoscopically harvested venous conduits were used. Intraoperative graft characteristics and flows were collected. Graft patency was blindly evaluated by a follow-up computed tomography at 11.4 weeks (median). RESULTS Graft occlusion rate was 5.2% (n = 22 of 422; 8% venous and 3% arterial). Thirteen were performed on non-significant proximal stenosis while 9 on occluded or >70% stenosed arteries. Arterial and venous graft MGF were lower in females (Parterial = 0.010, Pvenous = 0.009), with median differences of 10 and 13.5 ml/min, respectively. Arterial and venous MGF were associated positively with target vessel diameter ≥1.75 mm (Parterial = 0.025; Pvenous = 0.002) and negatively with pulsatility index (Parterial < 0.001; Pvenous < 0.001). MGF was an independent predictor of graft occlusion, adjusting for EuroSCORE-II, pulsatility index, graft size and graft type (arterial/venous). An MGF cut-off of 26.5 ml/min for arterial (sensitivity 83.3%, specificity 80%) and 36.5 ml/min for venous grafts (sensitivity 75%, specificity 62%) performed well in predicting early graft occlusion. CONCLUSIONS We demonstrate that MGF absolute values are influenced by coronary size, gender and graft type. Intraoperative MGF of >26.5 ml/min for arterial and >36.5 ml/min for venous grafts is the most reliable independent predictor of early graft patency. Modern-era coronary artery bypass graft is associated with low early graft failure rates when transit time flow measurement is used to provide effective intraoperative quality assurance.

中文翻译：

---

移植血流评估和早期冠状动脉旁路移植失败：计算机断层扫描分析

目的 我们通过计算机断层扫描评估移植物通畅性，并探讨术中平均移植物流量 (MGF) 的决定因素及其对预测早期移植物闭塞的贡献。方法 前瞻性招募了一位外科医生治疗的 148 名患者。使用动脉和内窥镜采集的静脉导管。收集术中移植物特征和流量。在 11.4 周（中位数）时通过随访计算机断层扫描盲目评估移植物通畅性。结果 移植物闭塞率为 5.2%（n = 422 例中的 22 例；8% 为静脉，3% 为动脉）。13次是针对非显着的近端狭窄进行的，而9次是针对闭塞或>70％狭窄的动脉进行的。女性的动脉和静脉移植物 MGF 较低（部分 = 0.010，静脉 = 0.009），中位差异分别为 10 和 13.5 ml/min。动脉和静脉 MGF 与目标血管直径 ≥1.75 mm 呈正相关（部分 = 0.025；静脉 = 0.002），与搏动指数呈负相关（部分 < 0.001；静脉 < 0.001）。MGF 是移植物闭塞的独立预测因子，根据 EuroSCORE-II、搏动指数、移植物大小和移植物类型（动脉/静脉）进行调整。动脉 MGF 截止值为 26.5 ml/min（敏感性 83.3%，特异性 80%），静脉移植物 36.5 ml/min（敏感性 75%，特异性 62%）在预测早期移植物闭塞方面表现良好。结论 我们证明 MGF 绝对值受冠状动脉大小、性别和移植物类型的影响。动脉移植物的术中MGF≥26.5ml/min，静脉移植物的术中MGF≥36.5ml/min是早期移植物通畅的最可靠的独立预测因子。当使用通过时间流量测量来提供有效的术中质量保证时，现代冠状动脉旁路移植术与较低的早期移植失败率相关。