A comparison of transit-time flowmetry and intraoperative fluorescence imaging for assessing coronary artery bypass graft patency

Abstract

In most patients, both intraoperative fluorescence imaging and transit-time flowmetry are useful to confirm intraoperative graft patency. However, in a small proportion of patients (10%), graft patency assessment with transit-time flowmetry alone might prompt unnecessary graft revision.

Image-Guided Quantification of Cardioplegia Delivery during Cardiac Surgery

“…24,25 In a series of 100 patients, Balacumaraswami, et al used intraoperative cardiac fluorescence imaging with ICG to evaluate graft patency and found 8 graft failures in 241 total grafts. 26 Such immediate intraoperative quality control is becoming increasingly important as coronary operations become more complex.…”

“…This system can also provide optical coronary angiography 10 and post-bypass graft patency evaluation without the attendant hazards of ionizing radiation. 25,26 Such a system should allow surgeons to more readily identify regions of poor myocardial protection and guide interventions to ameliorate intraoperative myocardial injury in the hopes of improving patient outcomes. C. Cross-sectional analysis from base (left) to apex (right) of the heart from (B).…”

Enhanced Surgical Imaging: Laparoscopic Vessel Identification and Assessment of Tissue Oxygenation

“…Of those studies attempting to measure endorgan oxygenation, oxymeters (21) and spectrophotometer probes (25) have been utilized and were found either to ineffective or provided only a limited sampling of tissue oxygenation. Many technologies employed by other specialties measure flow to an organ and not actual tissue oxygenation (26)(27)(28)(29)(30), or measure postoperative oxygenation(31,32). 3-CCD enhancement allows for a quantifiable, intraoperative assessment of renal oxygenation and could provide critical data about the blood supply to the kidney.…”

“…Vascular surgeons, during open and endovascular abdominal aortic aneurysm (AAA) repair have sought ways to detect ischemic colitis intraoperatively before the procedure is completed (20,21,25,38). Similar technology is being investigated by cardiac surgeons to assess graft-patency intraoperatively during coronary artery bypass grafts (26)(27)(28). Infrared imaging has been investigated in cardiac surgery; however, this technique does not give actual values for oxygen saturations (27,28).…”

‘Go with the flow ’: A review of methods and advancements in blood flow imaging

“…The ICG dye is intravenously introduced to the patient and upon accumulation in the location of interest, it is laser excited and the resulting fluorescence is detected by a CCD camera. ICG fluorescence analysis has been employed in numerous environments for example in the assessment of burn depth [75]; intraoperative skin flap viability [74] and the patency of coronary artery bypass grafts [76]; the feasibility of detection of exogenous chromophores in the adult human brain has been demonstrated; and ICG contrast agents have been used in various oncological studies, i.e. the detection of carcinogenic cells with a sensitivity of 1 : 10 7 in the background of normal cells [77] and in the analysis of lymph flow in breast cancer patients [78].…”