Advantages of intraoperative fluorescence imaging during coronary artery bypass grafting

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Aims: This report describes the complementary use of TTFM and IFI during off-pump coronary artery bypass grafting (OPCAB), and compares their results to those of subsequent coronary angiography. Subjects and Methods: The subjects were 159 OPCAB patients at a single center between April 2009 and November 2011. During surgery, all grafts were assessed initially by TTFM; poor-scoring grafts were inspected, and some were revised. IFI was then applied to check patency. For IFI, ICG was injected into the superior vena cava, then presence and timing of fluorescent enhancement were monitored in coronary and graft vessels. Results: Despite some poor TTFM scores, even after revision, subsequent IFI showed all grafts to be patent. Consistent with those IFI findings, angiography about one week after surgery showed that all 385 arterial grafts remained patent, and no patients showed ischemia during stress myocardial scintigraphy, though 2 of the 50 venous grafts had become occluded. IFI delayed enhancement also proved significant with bilateral ITAs. Conclusions: IFI and TTFM, both considered valuable for intraoperative graft assessment, are fundamentally different approaches. IFI often gives valid positive indications of graft patency despite poor TTFM scores.