The role of transit-time flow measurement and epicardial ultrasound in coronary artery bypass surgery: application of clinical practice

Introduction: Coronary artery bypass grafting remains the most commonly performed procedure for coronary artery disease. Technological and surgical innovations, including off-pump and minimally invasive surgery, have reduced risks and shortened recovery time, but demand higher technical expertise. Moreover, modern medicine also requires higher safety standards, transit-time flow measurement and epicardial ultrasound are essential techniques used for quality assesment and identifying issue during coronary artery bypass grafting surgery. Objective: To evaluate the impact of transit-time flow measurement and epicardial ultrasound in patients undergoing coronary artery bypass grafting surgery. Methods: A retrospective analysis of patients who underwent coronary artery bypass grafting surgery with the use of transit-time flow measurement and epicardial ultrasound. Identify the rate of changes in the selection of anastomosis sites based on epicardial ultrasound, assess graft quality using transit-time flow measurement parameters, and identify the rate of required revisions. Evaluate the rate of in-hospital mortality and major morbidity. Results: From January 2021 to October 2024, 98 patients underwent coronary artery bypass grafting surgery with transit-time flow measurement and epicardial ultrasound at Military Hospital 175. Mean age was 61.9 years, with 24.8% female, and diabetes mellitus was 36.7%. Off-pump coronary artery bypass surgery was performed in 80.6% (n=79) of cases, minimally invasive direct coronary artery bypass in 9.2% (n=9), traditional on-pump coronary artery bypass surgery in 17.3% (n=17), and on-pump beating heart surgery in 2% (n=2). Surgical changes were made in 33.7% of patients (n=98), with 72.7% (24 out of 33) based on findings from transit-time flow measurement and/or epicardial ultrasound. Surgical changes were related to the aorta in 10.4%, to graft vessels in 2.6%, and coronary targets in 8.3%. The rate of change in the selection of anastomosis placement based on epicardial ultrasound is 10.8% (25/230).The rate of graft revision is 0.9%. The in-hospital mortality rate was 3.1%, cerebrovascular events in 2.0%, and no new myocardial infarctions were reported. Conclusion: Surgical changes related to the aorta, graft vessels, coronary targets, and anastomosis were performed in 33.7% of patients, contributing to low surgical mortality and severe complication rates. The combined use of transit-time flow measurement and epicardial ultrasound can enhance the quality, safety, and efficacy of coronary artery bypass grafting procedures and should be considered a standard for routine application.