title: Target vessel detection and coronary anastomosis assessment by intraoperative 12-MHz ultrasound.
abstract: OBJECTIVE
  Our aim was to assess whether the left internal mammary artery, left anterior descending artery, and anastomosis could be visualized by intraoperative ultrasound for safe graft harvesting, optimal anastomotic target selection, and quality control.
  
  
  METHODS
  In 10 patients, the left internal mammary artery, the left anterior descending artery, and the constructed anastomosis were scanned with 12-MHz epicardial ultrasound. Anastomosis quality was assessed on ultrasound and compared with surgeon score.
  
  
  RESULTS
  All left internal mammary arteries and left anterior descending arteries could be identified, and pathways could be followed on the ultrasound. Plaque and calcifications were detectable. Deviation from initial coronary anastomotic target was necessary in 2 of 10 patients. None of the constructed anastomoses needed revision. On the anastomotic scans, six anastomoses scored satisfactory and four scored good.
  
  
  CONCLUSIONS
  Epicardial ultrasound was able to evaluate vessel characteristics and coronary anastomosis patency. This can lead to correction of surgical technique related problems in the operating room, possibly improving graft patency. Further advancements could make epicardial ultrasound a cost effective standard for anastomotic quality control. Applying it during robotic-assisted bypass surgery could make this procedure appropriate for more patients.
authors.affiliation: Intuitive Surgical, Inc, Sunnyvale, California 94086, USA. hubert.stein@intusurg.com
authors.forename: Hubert
authors.initials: H
authors.lastname: Stein
authors.forename: John Michael
authors.initials: JM
authors.lastname: Smith
authors.forename: John R
authors.initials: JR
authors.lastname: Robinson
authors.forename: Marc R
authors.initials: MR
authors.lastname: Katz
mesh_terms: D000368:Aged; D001161:Arteriosclerosis / Q000000981:diagnostic imaging; D002114:Calcinosis / Q000000981:diagnostic imaging; D047549:Coronary Artery Bypass, Off-Pump / Q000379:methods; D003331:Coronary Vessels / Q000000981:diagnostic imaging* / Q000601:surgery; D005260:Female; D006083:Graft Occlusion, Vascular / Q000000981:diagnostic imaging; D006801:Humans; D007387:Internal Mammary-Coronary Artery Anastomosis / Q000379:methods*; D007430:Intraoperative Care; D008297:Male; D008323:Mammary Arteries / Q000000981:diagnostic imaging* / Q000637:transplantation; D008875:Middle Aged; D010820:Physicians / Q000523:psychology; D013903:Thoracic Surgery; D020858:Tissue and Organ Harvesting / Q000379:methods*; D018084:Ultrasonography, Interventional / Q000295:instrumentation