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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

^a Department of Cardiovascular Control, Kochi Medical School, Nankoku, Kochi 783-8505, Japan
^b Department of Surgery 2, Kochi Medical School, Nankoku, Japan

*Corresponding author. Tel.: +81-88-880-2309; fax: +81-88-880-2310.

E-mail address: takemi{at}mpd.biglobe.ne.jp (T. Handa).

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).

Key Words: Indocyanine green angiography; Coronary artery bypass graft; Intraoperative graft assessment; New device