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Intraoperative Graft Assessment OPCAB Made in Japan

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Off-Pump Coronary Artery Bypass

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Abstract

Intraoperative graft evaluation is important because early graft failure is not rare. Several investigators have reported that graft failure at one year after surgery is approximately 20 % and immediate graft failure occurs in 3.2 % of the grafts (7.6 % of patients) during surgery. These early failures are often associated with technical issues that could be solved promptly if adequately diagnosed intraoperatively. Transit-time flow measurement (TTFM) and intraoperative fluorescence imaging (IFI) are currently most commonly used systems for intraoperative graft assessment. Both systems will reliably detect occluded grafts but cannot consistently detect more minor, nonocclusive abnormalities. The strengths of the IFI system are that it is a safe, simple, and repeatable technique, but its limitations are that it only provides a semiquantitative estimate of graft flow and does not show accurate anastomotic quality. On the other hand, TTFM provides more objective measurements of graft flow but is more likely to both underestimate and overestimate the need for graft revision. High-frequency epicardial ultrasound effectively helps the surgeons to cope with intraoperative challenges: (1) identify the location of target coronary arteries, (2) select the optimal anastomotic sites, and (3) assess the quality of constructed anastomoses.

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Authors and Affiliations

  1. Division of Cardiovascular Surgery, Department of Surgery, Shiga University of Medical Science, Ootsu, Japan

    Takeshi Kinoshita & Tohru Asai

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  1. Takeshi Kinoshita
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  2. Tohru Asai
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Correspondence to Takeshi Kinoshita .

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Editors and Affiliations

  1. Division of Cardiovascular Surgery, Department of Surgery, Shiga University of Medical Science, Otsu, Shiga, Japan

    Tohru Asai

  2. Department of Cardiovascular Surgery, Nippon Medical School, Bunkyo-ku, Tokyo, Japan

    Masami Ochi

  3. Department of Cardiovascular Surgery, Fukushima Medical University, Fukushima, Fukushima, Japan

    Hitoshi Yokoyama

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Kinoshita, T., Asai, T. (2016). Intraoperative Graft Assessment OPCAB Made in Japan. In: Asai, T., Ochi, M., Yokoyama, H. (eds) Off-Pump Coronary Artery Bypass. Springer, Tokyo. https://doi.org/10.1007/978-4-431-54986-4_18

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  • DOI: https://doi.org/10.1007/978-4-431-54986-4_18

  • Publisher Name: Springer, Tokyo

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  • Online ISBN: 978-4-431-54986-4

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