Intraoperative grafts assessment.

Area of Science:

• Cardiovascular Surgery
• Medical Imaging
• Interventional Cardiology

Background:

• Graft patency is critical for successful coronary artery bypass grafting (CABG) outcomes.
• Current CABG standards lack routine intraoperative imaging for graft assessment.
• Transit time flow measurement (TTFM) and intraoperative fluorescence imaging (IFI) are used but have limitations in detecting subtle graft abnormalities.

Purpose of the Study:

• To evaluate the utility of intraoperative imaging techniques for assessing coronary artery bypass graft integrity.
• To highlight the limitations of current methods (TTFM and IFI) in identifying suboptimal grafts.
• To introduce the potential of hybrid suites for routine completion angiography in CABG.

Main Methods:

• Review of existing intraoperative graft assessment techniques: TTFM and IFI.
• Discussion of the capabilities and limitations of TTFM (quantitative flow) and IFI (semiquantitative imaging).
• Introduction of hybrid suites enabling intraoperative angiography post-CABG.

Main Results:

• TTFM and IFI can identify completely patent or occluded grafts but struggle with subtle abnormalities.
• Suboptimal grafts identified by these methods are associated with poor long-term patency.
• Intraoperative angiography in hybrid suites can detect abnormal grafts missed by TTFM and IFI.

Conclusions:

• Neither TTFM nor IFI are sufficiently sensitive or specific for detecting all functionally significant graft abnormalities.
• Hybrid suites facilitating routine completion angiography offer a solution for identifying and revising suboptimal grafts before OR closure.
• This approach has the potential to improve long-term graft patency and patient outcomes after CABG.