Intraoperative graft verification in coronary surgery: increased diagnostic accuracy adding high-resolution epicardial ultrasonography to transit-time flow measurement

Giammarco, Gabriele Di; Canosa, Carlo; Foschi, Massimiliano; Rabozzi, Roberto; Marinelli, Daniele; Masuyama, Shinji; Ibrahim, Bedir M.; Ranalletta, Remo Antonio; Penco, María; Mauro, Michele Di

doi:10.1093/ejcts/ezt580

Cited by 69 publications

(59 citation statements)

References 23 publications

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“…Many reports in literature demonstrated that severity of coronary artery stenosis, TTFM parameters, and severity of to and fro flow on TTFM were risk factors for further graft failure [19][20][21][22][23][24]. In the present study, we found major four types of the flow dynamics.…”

Section: The Relationship Between Hems Parameters and Cag Outcomesupporting

confidence: 63%

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New Quantitative Analysis Method Using HyperEye Medical System Image for Coronary Artery Bypass Grafting

Takemi¹,

Orihashi²,

Nishimori³

et al. 2017

Angiol

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Purpose: The current evaluation by indocyanine green angiography in coronary artery bypass patients has been performed by qualitative analysis. We devised an original quantitative analysis method using Image J.Methods: Indocyanine green angiography movie was converted to spatiotemporal images. Using the spatiotemporal image, an indocyanine green fluorescence intensity curve was drawn and converted to a firstderivative (acceleration) curve. Indocyanine green angiography evaluations were classified into four types. We collected the peak indocyanine green fluorescence intensity value (peak-I) and both time interval and ratio of maximum indocyanine green acceleration value (max dI/dt) between the mid and distal portions of the graft. Results:In 61 left internal thoracic artery grafts, 49 were patent and 12 were abnormal on CAG. There were significant differences between peak-I at the mid portion of the graft (221.47 ± 39.33 vs. 184.82 ± 40.15 gray scale) and time delay with max dI/dt (0.45 ± 1.28 vs. −1.00 ± 1.25 s), but there was no significant difference in the ratio of max dI/dt between patent and abnormal grafts. Conclusions:The spatiotemporal image method may become a model of the analysis software and the time interval of max dI/dt may become a predictor for future graft failure.

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Section: The Relationship Between Hems Parameters and Cag Outcomesupporting

confidence: 63%

“…TTFM and high-frequency epicardial ultrasound have been used as popular tools in CABG [15][16][17][18][19][20][21][22][23][24]. Likewise, ICG-AG has been commonly used for evaluating graft patency.…”

Section: Discussionmentioning

confidence: 99%

New Quantitative Analysis Method Using HyperEye Medical System Image for Coronary Artery Bypass Grafting

Takemi¹,

Orihashi²,

Nishimori³

et al. 2017

Angiol

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“…The TTFM console we currently use in the preclinical animal study disposes of epicardial ultrasound imaging. If there is still uncertainty regarding the quality of the anastomosis after the flow measurements, a real-time epicardial ultrasound image can be of great help in further evaluation of the anastomosis, hereby increasing the diagnostic accuracy [27][28][29][30][31] .…”

Section: Discussionmentioning

confidence: 99%

Evaluation of a Novel Laser-assisted Coronary Anastomotic Connector - the Trinity Clip - in a Porcine Off-pump Bypass Model

Stecher¹,

Bronkers²,

Noest³

et al. 2014

JoVE

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To simplify and facilitate beating heart (i.e., off-pump), minimally invasive coronary artery bypass surgery, a new coronary anastomotic connector, the Trinity Clip, is developed based on the excimer laser-assisted nonocclusive anastomosis technique. The Trinity Clip connector enables simplified, sutureless, and nonocclusive connection of the graft to the coronary artery, and an excimer laser catheter laser-punches the opening of the anastomosis. Consequently, owing to the complete nonocclusive anastomosis construction, coronary conditioning (i.e., occluding or shunting) is not necessary, in contrast to the conventional anastomotic technique, hence simplifying the off-pump bypass procedure. Prior to clinical application in coronary artery bypass grafting, the safety and quality of this novel connector will be evaluated in a long-term experimental porcine off-pump coronary artery bypass (OPCAB) study. In this paper, we describe how to evaluate the coronary anastomosis in the porcine OPCAB model using various techniques to assess its quality. Representative results are summarized and visually demonstrated.

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“…Indocyanine green fluoroscopy and transit-time ultrasound flowmetry are validated and easy to use means of identifying graft errors and surgical correction intraoperatively [8,[15][16][17][18][19]. However, they pose potential risks to the patient by prolonging cross-clamp and cardiopulmonary bypass times, and they may theoretically could lead to poorer anastomosis quality and patency by inappropriate revision.…”

Section: Detection Of Graft Failurementioning

confidence: 99%

Early graft failure after coronary artery bypass grafting: diagnosis and treatment

Türk

2016

Eur Res J

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Early postoperative graft failure after coronary artery bypass grafting (CABG) is still a significant problem that results in high morbidity and mortality. Different therapeutic options are available to manage this complication which include reoperation, balloon angioplasty, angioplasty along with stenting and conservative medical management. Herein, we review the existing literature in diagnosis and treatment options for overcoming early graft failure immediately following CABG.Eur Res J 2016;2(2):85-92

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Intraoperative graft verification in coronary surgery: increased diagnostic accuracy adding high-resolution epicardial ultrasonography to transit-time flow measurement

Abstract: HR-ECUS should be considered complimentary to TTFM. Simultaneous use of the two methods during CABG provides morphological and functional information improving considerably diagnostic accuracy of intraoperative graft verification procedure close to 100%.

Cited by 69 publications

References 23 publications

New Quantitative Analysis Method Using HyperEye Medical System Image for Coronary Artery Bypass Grafting

New Quantitative Analysis Method Using HyperEye Medical System Image for Coronary Artery Bypass Grafting

Evaluation of a Novel Laser-assisted Coronary Anastomotic Connector - the Trinity Clip - in a Porcine Off-pump Bypass Model

Early graft failure after coronary artery bypass grafting: diagnosis and treatment

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