Waseda Katsuhisa, Ako Junya, Hasegawa Takao, Shimada Yoshihisa, Ikeno Fumiaki, Ishikawa Toshihiro, Demura Yoshitaka, Hatada Kazuyoshi, Yock Paul G, Honda Yasuhiro, Fitzgerald Peter J, Takahashi Masao
Stanford University Medical Center, Stanford, California 94305, USA.
JACC Cardiovasc Imaging. 2009 May;2(5):604-12. doi: 10.1016/j.jcmg.2008.12.028.
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.
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.
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).
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.
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.
本研究旨在评估术中荧光成像（IFI）系统在非体外循环冠状动脉搭桥术中实时评估移植物通畅情况的效果。
术中荧光成像是一种类似术中血管造影的成像方式，使用激光激发的荧光吲哚菁绿。最近，使用IFI系统评估移植物通畅情况已引入临床应用。IFI技术在非体外循环冠状动脉搭桥术中的可行性和有效性尚未与其他传统诊断方式进行系统比较。
接受非体外循环冠状动脉搭桥术的患者接受IFI分析、术中通过时间血流测定和术后X线血管造影。在离线IFI分析中，根据吲哚菁绿洗脱所需心跳次数对移植物洗脱情况进行分类：快速洗脱（≤15次心跳）和缓慢洗脱（>15次心跳）。
137例患者共507个移植物接受了IFI分析。在所有IFI分析中，379个（75%）移植物直至远端吻合口均清晰可见。关于吻合口位置，前位与可完全分析图像的比例较高（90%）相关。无论移植物类型如何，超过80%的图像可分析。6个通过时间血流测定结果可接受的移植物经IFI诊断为移植物失败，需要现场对移植物进行修正。所有修正后的移植物通畅情况均经术后X线血管造影证实。相反，21个通过时间血流测定结果不理想的移植物经IFI显示通畅情况可接受。这些移植物被认为无需进行移植物修正，20个（95%）移植物经术后X线血管造影显示通畅。与缓慢洗脱相比，快速洗脱与术前较高的射血分数、使用乳内动脉移植物以及前位吻合口位置相关。
IFI系统能够对移植物通畅情况进行现场评估，提供形态学和功能信息。该技术可能有助于减少非体外循环搭桥患者与手术相关的早期移植物失败。
