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The impact of the quantitative assessment procedure for coronary artery bypass graft evaluations using high-resolution near-infrared fluorescence angiography

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Abstract

Purpose

Near-infrared angiography (NIR) is used for on-site graft assessment during coronary artery bypass grafting. This study evaluated the results of a quantitative NIR assessment using a new high-resolution NIR device (h-NIR) for graft assessment.

Methods

Forty-three patients were enrolled in our study. Internal thoracic artery (ITA) grafts anastomosed to the left anterior descending artery and examined intraoperatively using h-NIR were included. The ITA grafts were divided into 2 groups for a comparative analysis: patent grafts (P group; n = 37) and failed grafts (F group; n = 6). The graft flow was evaluated by a “quantitative NIR assessment”, and the fluorescence luminance intensity (FLI) was measured. Direct observation of the graft and anastomosis with h-NIR was also performed.

Results

The FLI was higher in the P group than in the F group. The receiver operating characteristic analysis revealed the following cut-off values for FLIs depending on imaging duration: 21.1% at 1 s, 35.5% at 2 s, 58.4% at 3 s, and 83.3% at 4 s. The sensitivity and specificity for detecting graft failure were 83.3% and 69.8–80.6%, respectively. Furthermore, h-NIR was also able to visualize arterial dissection in ITA grafts.

Conclusions

A quantitative NIR assessment with an h-NIR device can improve the detectability of anastomotic stenosis, and h-NIR successfully detected arterial dissection of grafts.

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Acknowledgements

We would like to thank the following clinical engineers for their technical support with the manipulation of the NIR device: Tomotaka Takeshima, Kazuhiro Imakubo, and Yoshinori Nomura. We also salute the co-medical staff and surgeons affiliated with the Department of Surgery 2, who performed the surgeries.

Funding

This work was supported by the Japan Society for the Promotion of Science KAKENHI [Grant Number 20437718] and Fujita Memorial Fund for Medical Research.

Author information

Authors and Affiliations

  1. Department of Surgery, Kidawara Hospital, Nakamura Ichijoh-dohri 3-3-25, Shimanto City, Kochi, 787-0025, Japan

    Masaki Yamamoto & Koichi Kidawawa

  2. Department of Surgery 2, Kochi Medical School, Kochi University, Nankoku City, Kochi, 783-8505, Japan

    Masaki Yamamoto, Takemi Handa & Kazumasa Orihashi

  3. Center for Photodynamic Medicine, Kochi Medical School, Kochi University, Nankoku City, Kochi, 783-8505, Japan

    Masaki Yamamoto, Keiji Inoue, Takayuki Sato, Kazuhiro Hanazaki & Kazumasa Orihashi

  4. Department of Civil and Environmental Engineering, Toyo University, Kawagoe City, Saitama, 350-8585, Japan

    Hitoshi Ninomiya

  5. Department of Urology, Kochi Medical School, Kochi University, Nankoku City, Kochi, 783-8505, Japan

    Keiji Inoue

  6. Department of Cardiovascular Control, Kochi Medical School,Kochi University, Nankoku City, Kochi, 783-8505, Japan

    Takayuki Sato

  7. Department of Surgery 1, Kochi Medical School, Kochi University, Nankoku City, Kochi, 783-8505, Japan

    Kazuhiro Hanazaki

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  1. Masaki Yamamoto
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  2. Hitoshi Ninomiya
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  3. Takemi Handa
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Correspondence to Masaki Yamamoto.

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Supplementary Information

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Supplementary file1 Near-infrared fluorescence angiographic image of case 1. There was 90% stenosis at the anastomotic site between the LITA and LAD, but the FLI of the LITA was increased. FLI, fluorescence luminance intensity; LITA, left internal thoracic artery; LAD, left anterior descending; SV, saphenous vein; RCA, right coronary artery; LCX, left circumflex artery (MPG 21514 KB)

595_2021_2357_MOESM2_ESM.tif

Supplementary file2 Correlation diagram comparing the fluorescence luminance intensity (FLI) and mean graft flow (MGF) (a) 1 s after graft enhancement, (b) 2 s after graft enhancement, (c) 3 s after graft enhancement, and (d) 4 s after graft enhancement. (TIF 193 KB)

Supplementary file3 Near-infrared fluorescence angiographic image. The FLI of LITA graft enhancement. Note that a fluorescence-lucent area suggesting graft dissection was observed in the LITA (arrow). FLI, fluorescence luminance intensity; LITA, left internal thoracic artery (MPG 21120 KB)

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Yamamoto, M., Ninomiya, H., Handa, T. et al. The impact of the quantitative assessment procedure for coronary artery bypass graft evaluations using high-resolution near-infrared fluorescence angiography. Surg Today 52, 485–493 (2022). https://doi.org/10.1007/s00595-021-02357-8

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  • DOI: https://doi.org/10.1007/s00595-021-02357-8

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