No abstract

The introduction of an ERAS programme after ILOG can significantly reduce TLOS without jeopardising patient safety or clinical outcomes. The successful introduction of an ERAS programme requires full motivation and support from all team members including the patient.

The T-ILVAS successfully supported the systemic circulation without anticoagulation for up to 210 days. Mechanical reliability and biocompatibility were demonstrated. Organ function remained within normal limits during continuous non-pulsatile flow.

No abstract

Early failure of coronary artery grafts is a major cause of morbidity and mortality after cardiac surgery and has been noted in up to 5-20% of patients [1]. There are particular concerns regarding the quality of the anastomoses during off-pump surgery [2]. Unfortunately it is clinically difficult to assess the patency of the grafts at the time of surgery. Several techniques have been described including electromagnetic, ultrasound, Doppler and thermal coronary angiography. These all have their limitations and are very often operator dependant. MethodsWe describe our early experiences with a novel indocyanine green (ICG) fluorescence imaging technique (SPY Novadaq Technologies Inc. Toronto, Canada). ICG binds extensively to plasma proteins and fluoresces when illuminated at 806 nm. This can then be detected by a charged couple device video camera. Using this technique a bolus of ICG is injected into a central vein. The heart is then illuminated with an 806-nm laser diode. A camera positioned over the heart detects the fluorescing blood in the superficial epicardial vessels and graft conduits. This is clearly displayed on a screen in the operating theatre. ResultsWe have used this technique in over 80 patients and observed 213 conduits. One surgeon, utilising arterial conduits with pedicled composite grafts, performed all the operations. Three quarters of the cases were offpump. The imaging technique was simple to perform, taking about 3 min per graft. There were no noted adverse side effects from injection of ICG. All conduits were viewed. Absent flow was detected in four grafts (5% of patients). In all these cases the surgeon either revised his anastomoses or added a distal graft. Satisfactory blood flow was then noted using the SPY camera. DiscussionOur early experience with this technique suggests that it is a safe, reproducible and speedy method of assessment of conduitsÕ patency at a time when it is still possible to revise the grafts surgically. Real-time observation of blood flow in the conduits was reassuring for both surgeon and anaesthetist. Further validation studies are planned.