The use of intraoperative graft assessment in guiding graft revision

Quality assurance (QA) in medicine is the practice of the prevention of errors and avoiding problems when delivering care in the form of medical therapy, both in terms of non-invasive and invasive procedures. It is rightly expected by patients. Up until the last 10 years, verification of intraoperative bypass graft patency was limited to a stable hemodynamic status, lack of electrocardiographic evidence of myocardial infarction and, if available, no new regional wall motion abnormalities on transesophageal echo. This perspective outlines two technologies for QA during coronary artery bypass graft (CABG) surgery: transit-time flow measurement (TTFM) for functional assessment of coronary grafts and anatomical evaluation with epicardial ultrasound (ECUS). TTFM is a seasoned technology, used since the late 1990s. ECUS is relatively new, used since 2012. TTFM alone, although useful for intraoperative bypass graft assessment, is not enough; 10–15% of graft values are ambiguous as to the efficacy of graft function. Therefore, although newer, ECUS is already being established as an indispensable tool for quality assessment in coronary surgery. The two modalities combined are vital for ‘state of the art’ intraoperative bypass graft assessment.