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Ann Thorac Surg 2007;83:2251-2257
© 2007 The Society of Thoracic Surgeons
Department of Cardiothoracic Surgery, John Radcliffe Hospital, University of Oxford, Headington, Oxford, United Kingdom
* Address correspondence to Dr Taggart, Department of Cardiothoracic Surgery, University of Oxford, John Radcliffe Hospital, Headley Way, Headington, Oxford, OX3 9DU, United Kingdom (Email: david.taggart{at}orh.nhs.uk).
Graft patency verification is increasingly recognized as an important component of coronary artery bypass grafting. Intuitively, eliminating intraoperative graft failure should reduce cardiac mortality and morbidity in the short term and improve clinical outcome in the long term. Although conventional angiography remains the gold standard technique for assessing graft patency, it is rarely available in the operating room and consequently several other less invasive approaches have been advocated. This article reviews the two currently most commonly used modalities for graft patency assessment, intraoperative fluorescence imaging and transit-time flowmetry, and discusses their value and limitations. Both techniques can reliably detect otherwise unsuspected occluded grafts and this is crucial for internal thoracic arteries because of their prognostic significance. Although neither technology can consistently identify more minor, non-occlusive abnormalities, the intraoperative fluorescence imaging technique seems to be more sensitive and less susceptible to "false positive" images.
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