LOW FLOW IMA ITS RESPONSE TO TOPICAL VASODILATORS AND ITS EFFECT ON PATIENTS OUTCOME IN CABG SURGERY

Abstract

Objective: To determine the frequency of low flow IMA, the effect oftopical vasodilators, its use on LAD and immediate post-operativeoutcome. Methodology: This cross-sectional study was conducted at DowUniversity Health Sciences, Karachi, from 1st January 2012 to 31stDecember 2014. Data was collected of patients who underwent CABG.Free flow of IMA was measured immediately after harvesting with asyringe. Data was analysed on SPSS 15 with sample t test used forcomparison. P-value of less than 0.05 was considered statisticallysignificant. Results: Total of 158 consecutive patients were included. Males were81.6%, with mean age of 52 years The mean flow was 11.6±9.6ml/30seconds.About 40 patients had IMA flow less than 5ml/30seconds(25.3%). The low flow IMA did not showed a good response to topicalvasodilators and its use on LAD showed significantly higher need ofinotropic support(p=0.004), more LCOS(p=0.022), more use ofIABP(p=0.028), and higher incidence of atrial fibrillation. The mortalityand readmission were also high but not reached to significant levels. Conclusion: Low flow IMA should be used cautiously on LAD. If low flowIMA after harvesting does not give good response to topical vasodilators itmay be better to use the vein graft on LAD. If use of low flow IMAnecessary than mechanical and pharmacological support should beconsider early. Key Words: CABG, Internal Mammary Artery, IMA Flow, LAD