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Interactive Cardiovascular and Thoracic Surgery 3:479-483(2004)
© 2004 European Association of Cardio-Thoracic Surgery


Institutional report - Coronary

SPYTM: an innovative intra-operative imaging system to evaluate graft patency during off-pump coronary artery bypass grafting

Masao Takahashi*, Toshihiro Ishikawa, Koichi Higashidani and Hiroki Katoh

Department of Cardiovascular Surgery, Hiratsuka Kyosai Heart Center, Hiratsuka Kyosai Hospital, 9-11, Oiwake, Hiratsuka, Kanagawa 254-8502, Japan

* Corresponding author. Tel.: +81-463-32-1950; fax: +81-463-31-1865
airdonut{at}kkr.hiratsuka.kanagawa.jp

Off-pump coronary artery bypass grafting (CABG) has been rapidly increased, because of its less invasiveness with low complications. However, graft patency rate highly depends on the operators' capability due to technical difficulties. The SPYTM system, based on the fluorescence of indocyanine green, is an innovative device that permits validation of graft patency intra-operatively. Real time images of grafts are obtained with no need for catheterization, X-rays or iodine contrast medium. High-quality images could be obtained in all 290 grafts of 72 off-pump CABG cases (mean 4.0 grafts per patient). Four anastomoses (1.4%), including two proximal and two distal, were revised because of defects detected by SPY images. In one case, the SPYTM system revealed no blood flow in a radial sequential graft, although transit-time flow meter measurements showed a diastolic dominant pattern. SPY images provide critical information to surgeons to detect non-patent grafts, allowing them to be revised while the patient is still on the operating table. Using the SPYTM system, technical failures could be completely resolved during surgery. The use of the SPYTM system for intra-operative graft validation during off-pump CABG may become the gold standard for surgical management in the near future.

Key Words: Off-pump coronary artery bypass grafting; Intra-operative graft validation; Indocyanine green; SPY system




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