Intraoperative fluorescence imaging system for on-site assessment of off-pump coronary artery bypass graft.
OBJECTIVE
The aim of this study was to evaluate the intraoperative fluorescence imaging (IFI) system in the real-time assessment of graft patency during off-pump coronary artery bypass graft.


BACKGROUND
Intraoperative fluorescence imaging is an intraoperative angiography-like imaging modality using fluorescent indocyanine green excited with laser light. Recently, assessment of graft patency using the IFI system was introduced into clinical use. The feasibility and efficacy of IFI technology in off-pump coronary artery bypass graft has not been systematically compared with other conventional diagnostic modalities.


METHODS
Patients undergoing off-pump coronary artery bypass graft received IFI analysis, intraoperative transit time flowmetry, and postoperative X-ray angiography. In off-line IFI analysis, the graft washout was classified based on the number of heartbeats required for indocyanine green washout: fast washout (<or=15 beats) and slow washout (>15 beats).


RESULTS
A total of 507 grafts in 137 patients received IFI analysis. Of all the IFI analyses, 379 (75%) grafts were visualized clearly up to the distal anastomosis. With regard to anastomosis location, anterior location was associated with a higher percentage of fully analyzable images (90%). More than 80% of images were analyzable, irrespective of graft type. Six grafts with acceptable transit time flowmetry results were diagnosed with graft failure by IFI, which required on-site graft revision. All revised grafts' patency was confirmed by post-operative X-ray angiography. Conversely, 21 grafts with unsatisfactory transit time flowmetry results demonstrated acceptable patency with IFI. Graft revision was considered unnecessary in these grafts, and 20 grafts (95%) were patent by post-operative X-ray angiography. Compared with slow washout, fast washout was associated with a higher preoperative ejection fraction, use of internal mammary artery grafts, and anterior anastomosis location.


CONCLUSIONS
The IFI system enables on-site assessment of graft patency, providing both morphologic and functional information. This technique may help reduce procedure-related, early graft failures in off-pump bypass patients.
Waseda
Katsuhisa
K
Stanford University Medical Center, Stanford, California 94305, USA.
Ako
Junya
J
Hasegawa
Takao
T
Shimada
Yoshihisa
Y
Ikeno
Fumiaki
F
Ishikawa
Toshihiro
T
Demura
Yoshitaka
Y
Hatada
Kazuyoshi
K
Yock
Paul G
PG
Honda
Yasuhiro
Y
Fitzgerald
Peter J
PJ
Takahashi
Masao
M
D000368:Aged; D001783:Blood Flow Velocity; D017023:Coronary Angiography; D047549:Coronary Artery Bypass, Off-Pump / Q000009:adverse effects; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D003326:Coronary Circulation; D015150:Echocardiography, Doppler; D005240:Feasibility Studies; D005260:Female; D005451:Fluorescein Angiography / Q000379:methods*; D005456:Fluorescent Dyes / Q000008:administration & dosage; D006083:Graft Occlusion, Vascular / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000503:physiopathology; D006801:Humans; D007208:Indocyanine Green / Q000008:administration & dosage; D007275:Injections, Intravenous; D007430:Intraoperative Care; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D011237:Predictive Value of Tests; D014654:Vascular Patency; D014741:Video Recording
D005456:Fluorescent Dyes; D007208:Indocyanine Green