Multi-arterial off-pump CABG With Intraoperative SPY
Tohru Asai, Shinya Terada, Takeshi Kinoshita, Tomoaki Suzuki.
Shiga University of Medical Science, Otsu, Japan.
Objective: Multiple arterial graftings has been recommended for CABG. However it is underused in the world. We have used multi-arterial graftings proactively with SPY, intraoperative assessment using Intraoperative fluorescence imaging (SPY). We aim to evaluate effectiveness to detact graft dysfunction for intraoperative revision. Methods: We have employed SPY for 200 consecutive isolated OPCAB using various graft conduits, RITA 168/200 (84%), LITA 192/200 (96%), GEA 126/200 (63%), SV 46/200 (23%). All arterial graft conduits were harvested skeletonaized. All were used as in-situ graftings. LAD was grafted with individual RITA or LITA. No composite grafting was used. Sequential grafting with non-LAD target was frequently used with ITA, GEA and SV. Total number of distal anastomoses is 709. 696 anastomoses were fully evaluated by SPY. We classified IFI imagings as follows. I, invisible, as a conduit not illuminated. F, fast, as a conduit illuminated within 8 seconds. S, slow, as a conduit illumination takes over 10 seconds. If there were competitive flow, we classified in three categories based on the flow direction. CA, antegrade, a graft flow is superior. CR, retrograde, a native coronary flow is superior. CC, coronary to coronary bypass. Results: SPY anastomoses imaging outcome was as follows. F 481, S 23, I 5, CA 39, CR 15, CC 10. Invisible 5 anastomoses out of 696 (0.72%) were revised based on SPY findings and they were reevaluated fine. Early postoperative graft evaluation were performed using CTA or angiogram prior to discharge in 169 patients (570 anastomoses). Over all patency rate was 98.3%. In early postop study, 10 invisible sites were either S, CR or CC intraoperative SPY assessments. All anastomoses with F or CA were patent. Conclusions: Multi-arterial graftings with intraoperative SPY assessment provides invaluable information for necessary graft revision and graft physiology.
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