A new and simplified method for coronary and graft imaging during CABG

Improvements in percutaneous catheter interventions and new technical demands in the practice of coronary surgery have increased the need for an accurate and easy-to-use imaging modality for validating the quality of bypass grafts in the operating room. This report examines the initial clinical use of fluorescent cardiac imaging, a technology that uses indocyanine green (ICG) with a portable imaging device to visualize coronary anatomy and grafts intraoperatively.

The modality was evaluated at two institutions in 20 patients undergoing non-emergent CABG or MIDCAB with respect to safety, feasibility of use, and image quality. Images were generated and acquired with a portable laser diode/infrared camera device after injection of 0.5 ml of ICG (0.5-5.0 mg/ml) either intravenously, via the antegrade cardioplegia cannula, or via the cardiopulmonary bypass circuit.

There were no ICG- or imaging device-related complications. The technology was easy-to-use during conventional CABG as well as MIDCAB and adequately demonstrated coronary anatomy, filling of the grafts, and graft patency in all but two patients. In one patient, the use of the modality resulted in the intraoperative recognition and revision of a non-functioning graft.

This technology is user-friendly in the operating room, appears to be safe, provides good-quality images of coronary anatomy and grafts, and holds promise as an intraoperative graft validation tool for conventional and minimally invasive CABG.