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Right arrow Coronary disease

Ann Thorac Surg 2006;82:1078-1084
© 2006 The Society of Thoracic Surgeons

New technology

Target Vessel Detection and Coronary Anastomosis Assessment by Intraoperative 12-MHz Ultrasound

Hubert Stein, BS, BMEa,*, John Michael Smith, MDb, John R. Robinson, MDb, Marc R. Katz, MDc

a Intuitive Surgical, Inc, Sunnyvale, California
b Department of Surgery, Division of Cardiothoracic Surgery, Good Samaritan Hospital, Cincinnati, Ohio
c Department of Cardiac Surgery, Henrico Doctor's Hospital, Richmond, Virginia

Accepted for publication March 15, 2006.

* Address correspondence to Mr Stein, Intuitive Surgical, Inc, 950 Kifer Rd, Sunnyvale, CA 94086 (Email: hubert.stein{at}intusurg.com).

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.




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[Abstract] [Full Text] [PDF]


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