Surgery · 2026
Indocyanine green dosing and imaging conditions for intraoperative fluorescence assessment during coronary artery bypass grafting: A systematic review.
СтатьяОбзорНазвание и аннотация: Перевод пока не подготовлен
Обработка статьи · этапы, ошибки и управление
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Aleman Rene, Napoli Federico, Jamroz Tatiana, Ahmadi Saman, Dip Fernando, Norese Mariano, Navia Jose, Brozzi Nicolas
Аннотация
BACKGROUND: Intraoperative indocyanine green fluorescence is used to assess graft filling and myocardial perfusion during coronary artery bypass grafting, although dosing and imaging protocols vary. This review evaluated dose, imaging conditions, visualization, technical abnormality detection, revision, quantitative perfusion, and safety.
METHODS: Ovid MEDLINE, CINAHL Plus, and the Cochrane Central Register of Controlled Trials were searched. Three reviewers selected studies and extracted data. Overlapping reports were reconciled into clusters. Doses were normalized to milligrams per injection. Risk of bias was assessed with design-appropriate instruments and certainty with the Grading of Recommendations Assessment, Development, and Evaluation framework. Findings were synthesized by application and imaging method.
RESULTS: Twenty-seven reports represented 20 clusters. Fluorescence appeared within 2-20 seconds. Fluorescence was detected in 525 of 533 conduits, and 379 of 507 grafts were fully analyzable. Indocyanine green findings prompted correction or revision in 5 of 348 conduits and 6 of 289, 8 of 533, and 4 of 107 grafts, with restored fluorescence or confirmed patency after intervention. In 139 grafts assessed against angiography, indocyanine green identified stenosis or occlusion with 83.3% sensitivity and 100% specificity. One randomized study reported normal indocyanine green findings in all 8 grafts meeting combined revision criteria. Quantitative fluorescence identified reduced intensity in 5 of 6 graft failures. Perfusion thresholds were met in 275 of 359 and 63 of 75 myocardial territories. Fixed doses ranged from 0.0125 to 6.25 mg per injection, without direct evidence defining an optimal regimen.
CONCLUSION: Indocyanine green fluorescence supports rapid visualization of graft filling and may assist intraoperative reassessment during coronary artery bypass grafting. This review defines the reported dose range and identifies the exposure, acquisition, outcome, and safety variables required for more consistent comparison and interpretation.
METHODS: Ovid MEDLINE, CINAHL Plus, and the Cochrane Central Register of Controlled Trials were searched. Three reviewers selected studies and extracted data. Overlapping reports were reconciled into clusters. Doses were normalized to milligrams per injection. Risk of bias was assessed with design-appropriate instruments and certainty with the Grading of Recommendations Assessment, Development, and Evaluation framework. Findings were synthesized by application and imaging method.
RESULTS: Twenty-seven reports represented 20 clusters. Fluorescence appeared within 2-20 seconds. Fluorescence was detected in 525 of 533 conduits, and 379 of 507 grafts were fully analyzable. Indocyanine green findings prompted correction or revision in 5 of 348 conduits and 6 of 289, 8 of 533, and 4 of 107 grafts, with restored fluorescence or confirmed patency after intervention. In 139 grafts assessed against angiography, indocyanine green identified stenosis or occlusion with 83.3% sensitivity and 100% specificity. One randomized study reported normal indocyanine green findings in all 8 grafts meeting combined revision criteria. Quantitative fluorescence identified reduced intensity in 5 of 6 graft failures. Perfusion thresholds were met in 275 of 359 and 63 of 75 myocardial territories. Fixed doses ranged from 0.0125 to 6.25 mg per injection, without direct evidence defining an optimal regimen.
CONCLUSION: Indocyanine green fluorescence supports rapid visualization of graft filling and may assist intraoperative reassessment during coronary artery bypass grafting. This review defines the reported dose range and identifies the exposure, acquisition, outcome, and safety variables required for more consistent comparison and interpretation.