Advertisement

Influence of residual coronary flow on bypass graft flow for graft assessment using near-infrared fluorescence angiography

  • 74 Accesses

Abstract

Purpose

Near-infrared fluorescence angiography (NIR) detects the attenuation of fluorescence luminance intensity (FLI) through coronary artery bypass grafts affected by anastomotic stenosis. This study investigates the influence of residual blood flow of the host coronary artery (Ho) on bypass graft (Gr) FLI using a coronary artery bypass (CABG) model.

Methods

A mock circuit system was created using artificial vessels and artificial blood was supplied to the Gr and the Ho. We used NIR to examine the changes in FLI through the Gr.

Results

The Gr FLI was significantly attenuated according to the degree of Gr stenosis. The Gr FLI did not differ significantly among all degrees of Ho stenosis. High FLI grafts included grafts with degrees of Gr stenosis ≤ 75%, regardless of the severity of Ho stenosis. Moderate and low FLI grafts had 90 or 99% Gr stenosis, regardless of the severity of Ho stenosis. Gr FLI with 99% Gr stenosis was higher in 99% Ho stenosis than in ≤ 90% Ho stenosis.

Conclusions

A high Gr FLI indicated the absence of ≥ 90% stenosis in the anastomosis and a low Gr FLI indicated severe stenosis in the anastomosis despite Ho stenosis. High Ho stenosis may prevent the attenuation of Gr FLI in severely stenosed grafts.

This is a preview of subscription content, log in to check access.

Access options

Buy single article

Instant unlimited access to the full article PDF.

US$ 39.95

Price includes VAT for USA

Subscribe to journal

Immediate online access to all issues from 2019. Subscription will auto renew annually.

US$ 99

This is the net price. Taxes to be calculated in checkout.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7

Abbreviations

CABG:

Coronary artery bypass grafting

NIR:

Near-infrared angiography

ICG:

Indocyanine green

FLI:

Fluorescence luminance intensity

Gr:

Bypass graft

Ho:

Host coronary artery

HEMS:

Hyper eye medical system

LED:

Light-emitting diode

TICs:

Time–intensity curves

References

  1. 1.

    Kleisli T, Cheng W, Jacobs MJ, Mirocha J, Derobertis MA, Kass RM, et al. In the current era, complete revascularization improves survival after coronary artery bypass surgery. J Thorac Cardiovasc Surg. 2005;129(6):1283–91.

  2. 2.

    Jokinen JJ, Werkkala K, Vainikka T, Perakyla T, Simpanen J, Ihlberg L. Clinical value of intra-operative transit-time flow measurement for coronary artery bypass grafting: a prospective angiography-controlled study. Eur J Cardiothorac Surg. 2011;39(6):918–23.

  3. 3.

    Desai ND, Miwa S, Kodama D, Cohen G, Christakis GT, Goldman BS, et al. Improving the quality of coronary bypass surgery with intraoperative angiography: validation of a new technique. J Am Coll Cardiol. 2005;46(8):1521–5.

  4. 4.

    Yamamoto M, Sasaguri S, Sato T. Assessing intraoperative blood flow in cardiovascular surgery. Surg Today. 2011;41(11):1467–74.

  5. 5.

    Balacumaraswami L, Abu-Omar Y, Choudhary B, Pigott D, Taggart DP. A comparison of transit-time flowmetry and intraoperative fluorescence imaging for assessing coronary artery bypass graft patency. J Thorac Cardiovasc Surg. 2005;130(2):315–20.

  6. 6.

    Kieser TM, Rose S, Kowalewski R, Belenkie I. Transit-time flow predicts outcomes in coronary artery bypass graft patients: a series of 1000 consecutive arterial grafts. Eur J Cardiothorac Surg. 2010;38(2):155–62.

  7. 7.

    Cherrick GR, Stein SW, Leevy CM, Davidson CS. Indocyanine green: observations on its physical properties, plasma decay, and hepatic extraction. J Clin Invest. 1960;39:592–600.

  8. 8.

    Detter C, Russ D, Iffland A, Wipper S, Schurr MO, Reichenspurner H, et al. Near-infrared fluorescence coronary angiography: a new noninvasive technology for intraoperative graft patency control. Heart Surg Forum. 2002;5(4):364–9.

  9. 9.

    Balacumaraswami L, Taggart DP. Intraoperative imaging techniques to assess coronary artery bypass graft patency. Ann Thorac Surg. 2007;83(6):2251–7.

  10. 10.

    Yamamoto M, Orihashi K, Nishimori H, Wariishi S, Fukutomi T, Kondo N, et al. Indocyanine green angiography for intra-operative assessment in vascular surgery. Eur J Vasc Endovasc Surg. 2012;43(4):426–32.

  11. 11.

    Yamamoto M, Orihashi K, Nishimori H, Handa T, Kondo N, Fukutomi T, et al. Efficacy of intraoperative HyperEye Medical System angiography for coronary artery bypass grafting. Surg Today. 2015;45(8):966–72.

  12. 12.

    Nordgaard H, Nordhaug D, Kirkeby-Garstad I, Lovstakken L, Vitale N, Haaverstad R. Different graft flow patterns due to competitive flow or stenosis in the coronary anastomosis assessed by transit-time flowmetry in a porcine model. Eur J Cardiothorac Surg. 2009;36(1):137–42; discussion 42.

  13. 13.

    Uchida N, Kawaue Y. Flow competition of the right gastroepiploic artery graft in coronary revascularization. Ann Thorac Surg. 1996;62(5):1342–6.

  14. 14.

    Yamamoto M, Nishimori H, Handa T, Fukutomi T, Kihara K, Tashiro M, et al. Quantitative assessment technique of HyperEye medical system angiography for coronary artery bypass grafting. Surg Today. 2017;47(2):210–7.

  15. 15.

    Shintani Y, Iino K, Yamamoto Y, Kato H, Takemura H, Kiwata T. Analysis of computational fluid dynamics and particle image velocimetry models of distal-end side-to-side and end-to-side anastomoses for coronary artery bypass grafting in a pulsatile flow. Circ J. 2017;82(1):110–7.

  16. 16.

    Ibrahim K, Vitale N, Kirkeby-Garstad I, Samstad S, Haaverstad R. Narrowing effect of off-pump CABG on the LIMA-LAD anastomosis: epicardial ultrasound assessment. Scand Cardiovasc J. 2008;42(2):105–9.

  17. 17.

    Kute SM, Vorp DA. The effect of proximal artery flow on the hemodynamics at the distal anastomosis of a vascular bypass graft: computational study. J Biomech Eng. 2001;123(3):277–83.

  18. 18.

    Yamamoto M, Ninomiya H, Tashiro M, Sato T, Handa T, Inoue K, et al. Evaluation of graft anastomosis using time-intensity curves and quantitative near-infrared fluorescence angiography during peripheral arterial bypass grafting. J Artif Org. 2019;22(2):160–8.

  19. 19.

    Ferguson TB Jr., Chen C, Babb JD, Efird JT, Daggubati R, Cahill JM. Fractional flow reserve-guided coronary artery bypass grafting: can intraoperative physiologic imaging guide decision making? J Thorac Cardiovasc Surg. 2013;146(4):824–35 e1.

  20. 20.

    Detter C, Wipper S, Russ D, Iffland A, Burdorf L, Thein E, et al. Fluorescent cardiac imaging: a novel intraoperative method for quantitative assessment of myocardial perfusion during graded coronary artery stenosis. Circulation. 2007;116(9):1007–144.

  21. 21.

    Balacumaraswami L, Abu-Omar Y, Anastasiadis K, Choudhary B, Pigott D, Yeong SK, et al. Does off-pump total arterial grafting increase the incidence of intraoperative graft failure? J Thorac Cardiovasc Surg. 2004;128(2):238–44.

Download references

Acknowledgements

We would like to thank Clinical Engineers Tomotaka Takeshima, Kazuhiro Imakubo, and Yoshinori Nomura for their technical support with the manipulation of NIR angiography.

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 (Grant Number: none).

Author information

Correspondence to Masaki Yamamoto.

Ethics declarations

Conflict of interest

We have no conflicts of interest to declare.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Yamamoto, M., Ninomiya, H., Miyashita, K. et al. Influence of residual coronary flow on bypass graft flow for graft assessment using near-infrared fluorescence angiography. Surg Today 50, 76–83 (2020) doi:10.1007/s00595-019-01850-5

Download citation

Keywords

  • Coronary artery bypass grafts
  • Fluorescence luminance intensity
  • Time–intensity curve
  • Flow competition