Intraoperative assessment of myocardial perfusion using near-infrared fluorescence and indocyanine green: A literature review

Background

Coronary artery bypass grafting (CABG) is among the most commonly performed major surgical procedures worldwide. While flow measurements help assess graft patency during surgery, there are limited tools available for surgeons to objectively evaluate myocardial perfusion after graft placement. Near-infrared fluorescence (NIRF) imaging shows promise in this area, offering real-time visualization of flow and perfusion without the need for radiation or nephrotoxic contrast agents. This review summarizes current knowledge of and developments in myocardial perfusion assessment via NIRF imaging, emphasizing the potential benefits of adding quantification to enhance this technique.

Methods

PubMed was searched for articles describing the use of NIRF imaging for myocardial perfusion assessment. Articles were subsequently analyzed based on study objectives, subjects, and quantification capabilities. Limitations, future directions, and comparisons with other techniques were examined to recognize patterns and describe the chronological developments in NIRF imaging for myocardial perfusion assessment.

Results

Twenty-eight articles were included, 11 of which explored quantification. Only 5 of these articles included patients. Aims and techniques varied significantly among studies. Compared to the abundance of qualitative assessments, quantified NIRF imaging in patients remains limited.

Conclusions

This literature review highlights that NIRF imaging has been broadly researched qualitatively, showing promise for guiding CABG surgery through visualization of graft flow. However, the critical step of incorporating quantification to accurately assess myocardial perfusion remains insufficiently explored. To optimize decision making during CABG surgery, future studies must focus on intraoperative application of quantified NIRF imaging in cardiovascular patients.