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Evaluation of a Novel Laser-assisted Coronary Anastomotic Connector - the Trinity Clip - in a Porcine Off-pump Bypass Model
Published on: November 24, 2014
Target vessel detection and coronary anastomosis assessment by intraoperative 12-MHz ultrasound
Hubert Stein1, John Michael Smith, John R Robinson
1Intuitive Surgical, Inc, Sunnyvale, California 94086, USA. hubert.stein@intusurg.com
Insights
Epicardial ultrasound effectively visualizes the left internal mammary artery and left anterior descending artery during coronary artery bypass grafting. This technology aids in safe graft harvesting and anastomotic quality control, potentially improving surgical outcomes.
Area of Science:
- Cardiovascular Surgery
- Medical Imaging
- Ultrasound Technology
Background:
- Coronary artery bypass grafting (CABG) is a critical procedure for treating coronary artery disease.
- Ensuring graft quality and accurate anastomosis is vital for long-term graft patency and patient outcomes.
- Intraoperative visualization tools can enhance surgical precision and reduce complications.
Purpose of the Study:
- To evaluate the utility of intraoperative epicardial ultrasound for visualizing key structures in CABG.
- To assess the ability of ultrasound to guide safe graft harvesting and anastomotic target selection.
- To determine if ultrasound can provide reliable quality control for coronary anastomoses.
Main Methods:
- A 12-MHz epicardial ultrasound probe was used to scan the left internal mammary artery (LIMA), left anterior descending artery (LAD), and anastomosis in 10 patients.
- Ultrasound assessments of anastomosis quality were compared with surgeon's subjective scoring.
- Vessel characteristics and patency were evaluated using the ultrasound imaging.
Main Results:
- Complete visualization of the LIMA and LAD, including their pathways, was achieved in all patients.
- Ultrasound successfully detected plaque and calcifications within the vessels.
- In 20% of cases, adjustments to the anastomotic target were necessary based on ultrasound findings.
- No anastomoses required revision after intraoperative assessment.
- Ultrasound scoring indicated satisfactory quality in 60% and good quality in 40% of anastomoses.
Conclusions:
- Epicardial ultrasound is effective for evaluating vessel characteristics and coronary anastomosis patency during CABG.
- Intraoperative ultrasound can identify and facilitate correction of surgical technique-related issues, potentially improving graft patency.
- Further development may establish epicardial ultrasound as a cost-effective standard for anastomotic quality control.
- Application in robotic-assisted bypass surgery could expand its utility to a broader patient population.
Purpose:
Our aim was to assess whether the left internal mammary artery, left anterior descending artery, and anastomosis could be visualized by intraoperative ultrasound for safe graft harvesting, optimal anastomotic target selection, and quality control.
Description:
In 10 patients, the left internal mammary artery, the left anterior descending artery, and the constructed anastomosis were scanned with 12-MHz epicardial ultrasound. Anastomosis quality was assessed on ultrasound and compared with surgeon score.
Evaluation:
All left internal mammary arteries and left anterior descending arteries could be identified, and pathways could be followed on the ultrasound. Plaque and calcifications were detectable. Deviation from initial coronary anastomotic target was necessary in 2 of 10 patients. None of the constructed anastomoses needed revision. On the anastomotic scans, six anastomoses scored satisfactory and four scored good.
Conclusions:
Epicardial ultrasound was able to evaluate vessel characteristics and coronary anastomosis patency. This can lead to correction of surgical technique related problems in the operating room, possibly improving graft patency. Further advancements could make epicardial ultrasound a cost effective standard for anastomotic quality control. Applying it during robotic-assisted bypass surgery could make this procedure appropriate for more patients.
