Taggart David P, Choudhary Bikram, Anastasiadis Kyriakos, Abu-Omar Yasir, Balacumaraswami Lognathen, Pigott David W
Department of Cardiothoracic Surgery, John Radcliffe Hospital, Oxford, United Kingdom.
Ann Thorac Surg. 2003 Mar;75(3):870-3. doi: 10.1016/s0003-4975(02)04669-6.
Early graft failure is a common cause of cardiac morbidity and mortality after coronary artery bypass grafting (CABG), and there is particular concern about graft patency in off-pump CABG. We describe our preliminary experience with a novel imaging technique (the SPY system), based on fluorescence of Indocyanine Green when exposed to near infrared light, for the intraoperative assessment of coronary graft patency.
Graft patency was assessed in patients undergoing off-pump and on-pump total arterial revascularization. The imaging technique requires injection of a 1-mL bolus of Indocyanine Green into the central venous line, followed by imaging with the SPY system.
We assessed intraoperative graft patency in 213 conduits in 84 patients (mean, 2.54 grafts per patient), of which, 65 (77%) were done off-pump. It took approximately 3 minutes to image each graft. Skeletonized conduits provided better visualization than pedicled ones. Fluorescence, confirming graft patency, was observed in all but four (1.9%) conduits in 4 (5%) patients. In these latter cases, graft revision was necessitated.
Fluorescence imaging of coronary grafts using the SPY is a uniquely simple, safe, noninvasive, and reproducible technique for intraoperative confirmation of graft patency. In 4 patients, it necessitated revision of the initial intraoperative procedure. Quantification of graft flow would enhance the value of the system.
早期移植物功能衰竭是冠状动脉旁路移植术（CABG）后心脏发病和死亡的常见原因，非体外循环冠状动脉旁路移植术（OPCABG）中移植物通畅性尤其受到关注。我们描述了我们使用一种新型成像技术（SPY系统）的初步经验，该技术基于吲哚菁绿在近红外光照射下的荧光，用于术中评估冠状动脉移植物的通畅性。
在接受非体外循环和体外循环全动脉血运重建的患者中评估移植物通畅性。该成像技术需要向中心静脉导管内注入1 mL吲哚菁绿推注剂，然后用SPY系统进行成像。
我们评估了84例患者（平均每位患者2.54个移植物）中213根血管移植物的术中通畅性，其中65例（77%）为非体外循环手术。每个移植物成像大约需要3分钟。去骨骼化血管移植物比带蒂血管移植物可视化效果更好。除4例（5%）患者中的4根（1.9%）血管移植物外，在所有血管移植物中均观察到荧光，证实移植物通畅。在这些后一种情况下，需要进行移植物修复。
使用SPY对冠状动脉移植物进行荧光成像，是一种独特的简单、安全、无创且可重复的技术，用于术中确认移植物通畅性。在4例患者中，它需要对最初的术中操作进行修复。移植物血流的量化将提高该系统的价值。
