Preliminary experience for the evaluation of the intraoperative graft patency with real color charge-coupled device camera system: an advanced device for simultaneous capturing of color and near-infrared images during coronary artery bypass graft☆

Abstract

We developed a new color charge-coupled device (CCD) camera for the intraoperative indocyanine green (ICG) angiography. This device consists of a combination of custom-made optical filters and an ultra-high sensitive CCD image sensor, which can detect simultaneously color and near-infrared (NIR) rays from 380 to 1200 nm. We showed a comparison between our system and other devices for the preliminary experience. We routinely performed both transit-time flowmetry (TFM) and color images for intraoperative assessment, thallium-scintigraphy for the early postoperative assessment, and then angiography after 1-year surgery. We also obtained intraoperative graft flows and images in 116 grafts. Although TFM indicated a graft patency, the CCD camera suspected perfusion failures in four grafts. Also the analysis of the ICG fluorescence intensity showed the significant hypoperfusion at the perfusion territory distal to the anastomosis (graft vs. perfusion territory; 230+/-26 vs. 156+/-13 a.u, P=0.02). When the CCD camera suspected a graft failure, CCD camera and angiography showed a comparable graft failure. The unique device that visualized ICG-enhanced structures against a background of natural myocardial color improved the visibility of abnormality in flow and perfusion. Our findings show that this device may become a standard intraoperative graft and perfusion assessment tool in coronary artery bypass graft (CABG).

Neurotoxic effects of indocyanine green -cerebellar granule cell culture viability study

“…These recommended doses of ICG administrated in adults correspond to 1.15-5.16 μM of ICG concentration in the brain tissue. Furthermore, it can be found in earlier publications that the typical ICG dose per measurement used in in-vivo experiments does not exceed 20 mg (corresponding to 2.58 μM concentration of ICG in the brain) [26,27,[42][43][44][45][46][47][48][49][50][51][52][53][54][55][56][57][58][59]. However it can be also found that some groups used 25 mg (3.83 μM in the brain) in a single dose [60][61][62][63][64] and even higher doses of ICG 0.5 mg/kg were reported in studies on humans [65][66][67].…”

Near-Infrared Fluorescence Imaging in Humans with Indocyanine Green: A Review and Update~!2009-12-07~!2009-12-23~!2010-05-26~!

“…The SPY system has been cleared by the Food and Drug Administration (FDA) exclusively for intraoperative imaging following intravenous administration of ICG. The final system, developed in the Kochi Medical School in Japan, uses LEDs, a cut-on filter passing light >840 nm, and a color CCD camera for intraoperative assessment of coronary artery bypass surgery [25]. Each of the six systems differs in the power, wavelength and bandwidth of excitation sources, and filtering strategy for rejection of backscattered excitation and ambient light that establishes the sensitivity level of the device.…”

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

“…Likewise, ICG-AG has been commonly used for evaluating graft patency. Many reports in literature demonstrated the effectiveness of ICG-AG for CABG [1][2][3][4][5]. In Japan, the SPY system and HEMS have been used for CABG; however, quantitative analysis has not been a popular method because a better analysis software program is not yet available.…”

“…Previously, we developed a prototype color ICG-AG system, the HyperEye Medical System (HEMS; Mizuho IKAKOGYO Inc., Tokyo, Japan), and have used it with TTFM (VeriQ; Medistim, Oslo, Norway) for intraoperative graft evaluation since 2007 [5,6]. Yamamoto et al reported the technique of quantitative assessment by using HEMS [7].…”