INTRAOPERATIVE ASSESSMENT OF CONDUITS QUALITY DURING CORONARY BYPASS SURGERY

Abstract

Myocardial revascularization by coronary bypass surgery is an effective intervention that provides relief from the symptoms of coronary artery disease and increases the lifetime of patients by preventing fatal cardiac complications. Improving the early and long-term results of coronary bypass surgery is a priority task for surgical treatment of coronary artery disease. The results of myocardial revascularization depend on many factors. One of the factors ensuring good results of coronary bypass surgery is the quality and duration of functioning of the conduits. Intraoperative quality control allows timely detection and elimination of defects in shunts. The control is carried out by several methods: palpation, intraoperative coronary angiography, conduit flowmetry with ultrasound imaging of anastomoses. Palpation and pumping of shunts are often used by surgeons as a screening method, allowing to determine the presence of blood flow, without quantitative and qualitative characteristics. Only with a lot of experience, the surgeon can be more or less confident in the method of palpation. The most reliable and informative method is a direct angiography of shunts, but it`s coupled with the difficulties of organizing the process, increasing the duration of the operation and resource costs. Flowmetry is not worse in sensitivity and informativeness then angiography and requires less resources and time. After the formation of anastomoses and the start of blood flow, the flowmetric sensor measures the volume of blood flow through shunts in a measured period, vascular resistance and diastolic flow, it can be concluded about the quality of the functioning of the conduit. In case of deviation of blood flow indicators from the permissible norm, it can be assumed that there were technical defects at the stage of formation of anastomoses and correct them before suturing the wound. Scanning with a high-frequency ultrasound sensor makes it possible to visualize anastomoses with high resolution, assess their geometry, the presence of stenoses and constrictions along the suture line, and color contrasting of blood flow and Dopplerography can reliably confirm the presence or absence of stenoses. Intraoperative monitoring of the conduits by flowmetry in combination with ultrasound imaging of anastomoses can reduce the percentage of bypass dysfunction, thus improving the immediate and long-term results of surgical treatment of coronary artery disease.