Preliminary experience with a novel intraoperative fluorescence imaging technique to evaluate the patency of bypass grafts in total arterial revascularization

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Presentation transcript:

Preliminary experience with a novel intraoperative fluorescence imaging technique to evaluate the patency of bypass grafts in total arterial revascularization David P Taggart, MD, PhD, Bikram Choudhary, MBBS, Kyriakos Anastasiadis, MD, Yasir Abu-Omar, MRCS, Lognathen Balacumaraswami, FRCS, David W Pigott, FRCA The Annals of Thoracic Surgery Volume 75, Issue 3, Pages 870-873 (March 2003) DOI: 10.1016/S0003-4975(02)04669-6

Fig 1 (A) SPY image showing an in situ left internal thoracic artery (LITA) graft to the left anterior descending (LAD) coronary artery. The native coronary arteries are occluded proximal to the anastomotic site using a sling so that flow in the coronary arteries is purely attributed to patency of the graft. Note that no fluorescence is seen in the LITA graft. As a result of this, a saphenous vein graft is placed onto the distal LAD (see B). (B) SPY image showing saphenous vein graft onto LAD. Note fluorescence in vein graft and native coronary artery. (SVG = saphenous vein graft.) The Annals of Thoracic Surgery 2003 75, 870-873DOI: (10.1016/S0003-4975(02)04669-6)

Fig 2 SPY image of in situ left internal thoracic artery (LITA) graft to left anterior descending (LAD) coronary artery, taken after revision of the anastomosis. The initial image showed no fluorescence in the LITA graft. The Annals of Thoracic Surgery 2003 75, 870-873DOI: (10.1016/S0003-4975(02)04669-6)

Fig 3 (A) SPY image showing in situ right internal thoracic artery (RITA) graft to the left anterior descending (LAD) coronary artery. A composite pedicled radial artery (RA) graft was placed from the RITA to the obtuse marginal artery. Note that no fluorescence was seen in the RITA distal to the RA anastomosis, which was taken down and reconstructed (see B). (B) SPY image taken after revision of RA-to-RITA anastomosis, seen in A. Note fluorescence now seen in distal portion of RITA graft and in LAD coronary artery. (OM = obtuse marginal coronary artery.) The Annals of Thoracic Surgery 2003 75, 870-873DOI: (10.1016/S0003-4975(02)04669-6)

Fig 4 (A) SPY image showing in situ left internal thoracic artery (LITA) graft onto obtuse marginal coronary artery (OM). Note that no fluorescence was seen in LITA or native coronary, necessitating revision of the distal anastomosis (see B). (B) SPY image taken after revision of the distal anastomosis in A. Note the fluorescence in LITA and in the OM coronary artery. The Annals of Thoracic Surgery 2003 75, 870-873DOI: (10.1016/S0003-4975(02)04669-6)