Image Guided Complete Revascularization
Can Intra-operative fluorescence angiography (IFVA) be used to provide a more complete revascularization procedure in patients with small targets, diffuse disease and/or poor conduits.
Cardiac Surgery is used to treat more severe forms of cardiac disease, offers more durable results than alternative therapies and treats disease not amenable to medical therapies or other interventional therapies.
Data has demonstrated that TMR improves long term angina relief, increases perfusion, and improves patient quality of life.
Patients presenting for CABG are getting older, sicker, and more complex. Complete revascularization is always the goal, but not always attainable. According to the BARI trial, 26% of CABG patients are incompletely revascularized and according to the ACC/AHA guidelines, angina is prevalent in over 20% of patients two years after CABG.
Transmyocardial Laser Revascularization (TMR) is performed to treat ischemic disease that is not amenable to medical therapy, percutaneous coronary intervention or direct coronary bypass.
Intra-operative Angiography may be used to locate and document regions of the microvascular myocardium that is not fully perfused by direct coronary bypass.
Image guided surgical revascularization provides a greater opportunity for complete revascularization. The use of IFVA may help to reduce post-operative complications, repeat interventions, and peri-operative graft failures; and it enables visualization of myocardial perfusion. IFVA is used to validate patency, address technical deficiencies and identify areas untreatable with bypass and therefore may provide indication for complimentary therapy including TMR. Patients undergoing repeat operation or with diffuse coronary disease and stable angina that present with areas of regional ischemia may benefit from TMR. Intra-operative Fluorescence Vascular Angiography (IFVA) is used to evaluate native and bypass graft function, distal outflow and perfusion to the microvascular bed.
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