Intraoperative fluorescence imaging system for on-site assessment of off-pump coronary artery bypass graft.
Intraoperative fluorescence imaging system for on-site assessment of off-pump coronary artery bypass graft.
复制标题
用于非体外循环冠状动脉旁路移植术现场评估的术中荧光成像系统。
DOI：
10.1016/j.jcmg.2008.12.028
复制
发表时间：
2009
期刊：
影响因子：
--
通讯作者：
Masao Takahashi
中科院分区：
文献类型：
--
作者：
K. Waseda;J. Ako;T. Hasegawa;Y. Shimada;F. Ikeno;T. Ishikawa;Y. Demura;K. Hatada;P. Yock;Y. Honda;P. Fitzgerald;Masao Takahashi
ObjectivesThe aim of this study was to evaluate the intraoperative fluorescence imaging（IFI）system in real-time assessment of graft patency during off-pump coronary artery bypass graft.BackgroundIntraoperative fluorescence imaging is a intraoperative angiography like imaging modality using fluorescent indocyanine绿色excited with laser light.最近，使用IFI系统评估移植物通畅性被引入临床使用。IFI技术在非体外循环冠状动脉旁路移植术的可行性和有效性还没有系统地比较与其他传统的诊断models.MethodsPatients接受非体外循环冠状动脉旁路移植术IFI分析，术中通过时间血流仪，术后X射线血管造影。在离线IFI分析中，根据吲哚菁绿绿色洗脱所需的心跳次数对移植物洗脱进行分类：快速洗脱（≤15次心跳）和缓慢洗脱（>15次心跳）。结果137例患者共507个移植物接受了IFI分析。在所有IFI分析中，379例（75%）移植物清晰可见，直至远端吻合。关于吻合位置，前部位置与更高百分比的完全可分析图像（90%）相关。无论移植物类型如何，超过80%的图像都是可分析的。通过IFI，6个具有可接受的通过时间血流测定结果的移植物被诊断为移植物失效，需要现场移植物翻修。术后X线血管造影证实了所有翻修移植物的通畅性。相反，21例通过时间血流测定结果不满意的移植物显示IFI的通畅性可接受。在这些移植物中，移植物翻修被认为是不必要的，术后X线血管造影显示20例移植物（95%）通畅。与缓慢冲洗相比，快速冲洗与较高的术前射血分数，内乳动脉移植物的使用，和前吻合location.ConclusionsThe IFI系统，使现场评估移植通畅性，提供形态和功能信息。这项技术可能有助于减少非体外循环旁路移植术患者手术相关的早期移植失败。
ObjectivesThe 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.BackgroundIntraoperative 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.MethodsPatients 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 (≤15 beats) and slow washout (>15 beats).ResultsA 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.ConclusionsThe 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.