Hassan Mohammed, Kerdok Amy, Engel Amy, Gersch Karen, Smith J Michael
Department of Cardiothoracic Surgery, Good Samaritan Hospital, Cincinnati, OH 45220, USA.
J Card Surg. 2012 Mar;27(2):158-62. doi: 10.1111/j.1540-8191.2011.01411.x. Epub 2012 Feb 28.
This study assessed the clinical utility of near-infrared fluorescence imaging using indocyanine green in off-pump beating heart total endoscopic and robotic-assisted coronary artery bypass using the fluorescence imaging system for the da Vinci Si on a canine model for vessel identification, graft patency, and correlation of graft patency with ultrasound transit-time flow measurement probe.
Beating heart total endoscopic robotic-assisted coronary artery bypass was performed on eight canine using indocyanine green and fluorescence imaging to identify the internal mammary artery prior to harvesting, the coronary vessel anatomy, and the patency of the beating heart total endoscopic coronary artery bypass anastomosis. Three to four injections of indocyanine green with a dose of 1.25 mg to 2.5 mg were administered per animal. Transit-time flow was measured in each of the dogs.
High definition 3D images were obtained. The camera working distance, indocyanine green dosage, internal mammary artery visualization, coronary artery visualization, patency by indocyanine green injection, and patency by transit-time flow were recorded. Six cases were completed successfully, and all demonstrated correlation between indocyanine green measurements of flow, and the transit-time flow measurement.
Use of near-infrared fluorescence with indocyanine green was feasible in our study, and would be of great benefit during total endoscopic robotic-assisted coronary artery bypass using the fluorescence imaging-capable da Vinci Si system to help identify the internal mammary artery, delineate the coronary anatomy, and also determine patency of the anastomoses. This procedure correlated well with transit-time flow measurement.
本研究在犬模型上，使用吲哚菁绿近红外荧光成像技术，通过达芬奇Si荧光成像系统，评估其在非体外循环心脏跳动下全内镜及机器人辅助冠状动脉搭桥术中用于血管识别、移植物通畅情况以及移植物通畅情况与超声通过时间血流测量探头相关性的临床效用。
对8只犬进行心脏跳动下全内镜机器人辅助冠状动脉搭桥术，使用吲哚菁绿和荧光成像技术在获取胸廓内动脉前识别其位置、冠状动脉血管解剖结构以及心脏跳动下全内镜冠状动脉搭桥吻合口的通畅情况。每只动物注射3至4次吲哚菁绿，剂量为1.25毫克至2.5毫克。测量每只犬的通过时间血流。
获得了高清3D图像。记录了摄像头工作距离、吲哚菁绿剂量、胸廓内动脉可视化情况、冠状动脉可视化情况、通过吲哚菁绿注射评估的通畅情况以及通过时间血流评估的通畅情况。6例手术成功完成，所有病例均显示吲哚菁绿血流测量与通过时间血流测量之间具有相关性。
在我们的研究中使用吲哚菁绿近红外荧光成像技术是可行的，在使用具备荧光成像功能的达芬奇Si系统进行全内镜机器人辅助冠状动脉搭桥术期间，其将大有裨益，有助于识别胸廓内动脉、描绘冠状动脉解剖结构，并确定吻合口的通畅情况。该方法与通过时间血流测量相关性良好。
