The National Institute for Health and Clinical Excellence (NICE) has issued full guidance to the NHS in England, Wales, Scotland and Northern Ireland on intraoperative flourescence angiography in coronary artery bypass grafting.
Coronary artery bypass grafting is one of the most common cardiac surgical interventions. In this procedure a section of vessel from another part of the body is used to reroute (bypass) blood around a blocked coronary artery and improve blood flow to the heart. Early blockage of the graft caused by narrowing and poor blood flow may be a significant cause of morbidity and mortality in patients who have undergone coronary artery bypass grafting.
Several techniques are used intraoperatively to assess graft patency. These include digital palpation, electromagnetic flow measurement, Doppler studies, and conventional and thermal coronary angiography techniques. A limitation with many of the imaging techniques is that they provide poor resolution and definition of the grafts.
Intraoperative fluorescence angiography allows confirmation of the location of the coronary arteries and assessment of bypass graft function during coronary artery bypass procedures. The intraoperative fluorescence imaging system consists of a video camera and a laser diode that emits monochromatic light. The camera, guided by a range-detector diode, is positioned a safe distance above the heart. A small amount of indocyanine green (ICG) dye is then administered as a central venous injection. This dye fluoresces when illuminated using laser energy and the images are recorded digitally.