Immediate impact of coronary artery bypass graft surgery on regional myocardial perfusion: Results from the Collaborative Pilot Study to Determine the Correlation Between Intraoperative Observations Using Spy Near-Infrared Imaging and Cardiac Catheterization Laboratory Physiological Assessment of Lesion Severity

Ashesh N Buch; Hazaim Alwair; Christopher M Cook; Ricardo Petraco; Jimmy T Efird; Christopher P Gregory; Arjun K Chagarlamudi; Justin E Davies; Tim P van de Hoef; T Bruce Ferguson Jr

doi:10.1016/j.xjon.2022.08.012

Immediate impact of coronary artery bypass graft surgery on regional myocardial perfusion: Results from the Collaborative Pilot Study to Determine the Correlation Between Intraoperative Observations Using Spy Near-Infrared Imaging and Cardiac Catheterization Laboratory Physiological Assessment of Lesion Severity

JTCVS Open. 2022 Sep 13:12:158-176. doi: 10.1016/j.xjon.2022.08.012. eCollection 2022 Dec.

Authors

Affiliations

¹ Department of Medicine, Chesapeake Regional Medical Center, Chesapeake, Va.
² Department of Cardiothoracic Surgery, Charleston Area Medical Center, Charleston, WVa.
³ The Essex Cardiothoracic Center, and Anglia Ruskin University, Cambridge, United Kingdom.
⁴ Imperial College Healthcare NHS Trust, London, United Kingdom.
⁵ Veterans Administration Cooperative Studies Program Coordinating Center, Boston VA Health System, Boston, Mass.
⁶ Department of Radiation Oncology, Case Western Reserve University School of Medicine, Cleveland, Ohio.
⁷ Vidant Cardiology, Vidant Medical Center, Greenville, NC.
⁸ Division of Cardiology, Department of Medicine, Oregon Health Sciences University, Portland, Ore.
⁹ Department of Clinical and Experimental Cardiology, Amsterdam UMC-University of Amsterdam, Amsterdam, The Netherlands.
¹⁰ Department of Engineering, East Carolina University, Greenville, NC.
¹¹ Department of Physics, East Carolina University, Greenville, NC.
¹² Department of Surgery, East Carolina University, Greenville, NC.

Abstract

Objectives: Coronary artery bypass grafting (CABG) is performed using anatomic guidance. Data connecting the physiologic significance of the coronary vessel stenosis to the acute physiologic response to grafting are lacking. The Collaborative Pilot Study to Determine the Correlation Between Intraoperative Observations Using Spy Near-Infrared Imaging and Cardiac Catheterization Laboratory Physiological Assessment of Lesion Severity study is the first to compare preintervention coronary physiology with the acute regional myocardial perfusion change (RMP-QC) at CABG in a per-graft analysis.

Methods: Non-emergent patients undergoing diagnostic catheterization suitable for multivessel CABG were enrolled. Synergy between Percutaneous Coronary Intervention with Taxus score, fractional flow reserve (FFR), instantaneous wave free ratio (iFR), and quantitative coronary angiography was documented in 75 epicardial coronary arteries, with 62 angiographically intermediate and 13 severe stenoses. At CABG, near-infrared fluorescence analysis quantified the relative change (post- vs pregrafting, termed RMP-QC) in the grafted vessel's perfusion territory. Scatter plots were constructed for RMP-QC versus quantitative coronary angiography and RMP-QC versus FFR/iFR. Exact quadrant randomization test for randomness was used.

Results: There was no relationship between RMP-QC and quantitative coronary angiography percent diameter stenosis, whether all study vessels were included (P = .949) or vessels with core-lab quantitative coronary angiography only (P = .922). A significant nonrandom association between RMP-QC and FFR (P = .025), as well as between RMP-QC and iFR (P = .008), was documented. These associations remained when excluding vessels with assigned FFR and iFR values (P = .0092 and P = .0006 for FFR and iFR, respectively).

Conclusions: The Collaborative Pilot Study to Determine the Correlation Between Intraoperative Observations Using Spy Near-Infrared Imaging and Cardiac Catheterization Laboratory Physiological Assessment of Lesion Severity study demonstrates there is no association between angiographic coronary stenosis severity and the acute perfusion change after grafting; there is an association between functional stenosis severity and absolute increase in regional myocardial perfusion after CABG.

Keywords: CABG, coronary artery bypass grafting; FFR, fractional flow reserve; HSR, hyperemic stenosis resistance index; NIRF, near-infrared fluorescence angiography; PCI, percutaneous coronary intervention; PERSEUS, Collaborative Pilot Study to Determine the Correlation Between Intraoperative Observations Using Spy Near-Infrared Imaging and Cardiac Catheterization Laboratory Physiological Assessment of Lesion Severity; QCA, quantitative coronary angiography; RMP-QC, quantified change in regional myocardial perfusion; SYNTAX, Synergy between Percutaneous Coronary Intervention with Taxus; bypass grafting; coronary physiology; iFR, instantaneous wave free ratio; myocardial perfusion.