2018 European Guidelines Stress Quality Measures
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The European Task Force on myocardial revascularization of the European Society of Cardiology (ESC) and European Association for Cardio-Thoracic Surgery
(EACTS), with the special contribution of the European Association for Percutaneous Cardiovascular Interventions (EAPCI), developed the The 2018 ESC/EACTS Guidelines on Myocardial Revascularization to provide a comprehensive roadmap to assist physicians in selecting the best management strategies for an individual patient with a given condition.
The guidelines integrate the most recent research (780 citations) with educational tools and implementation programs for its recommendations.
Graft flow during coronary artery bypass grafting (CABG) surgery is a major determinant in postoperative surgical success. Since 2010, The European Guidelines for Myocardial Revascularization have recommended its use. In the latest 2018 update of the Guidelines, routine intraoperative graft flow measurement is addressed in Section 15.1.7. It states:
“Besides continuous ECG monitoring and transoesophageal echocardiography immediately after revascularization, intraoperative quality control may also include graft flow measurement to confirm or exclude a technical graft problem.2 Transit-time flow measurement is the most frequently used technique for graft assessment and has been able to detect that 2-4% of grafts require revision. 2,3 In observational studies, the use of intraoperative graft assessment has been shown to reduce the rate of adverse events and graft failure, although interpretation can be challenging in sequential and T-graft configurations.2,4-6”
Some studies even suggest that quality measures during coronary artery bypass grafting (CABG), such as graft flow verification with transit-time ultrasound, are more important than simply the volume of surgeries performed by a center.7,8 “When quality indicators in hospitals strongly predicted mortality, irrespective of surgeon or hospital case volumes.”9