SPY + CABG + TMR = Image Guided Revascularization
The SPY imaging system can be used to guide a potentially 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.
Patients presenting for CABG are older and sicker, and therefore require more complex surgery. Complete revascularization is always the goal, but is 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.
Trans Myocardial Revascularization (TMR) is indicated for revascularization of ischemic myocardium not amenable to direct coronary revascularization. Data has demonstrated that TMR improves long term angina relief, increases perfusion, and improves patient quality of life. Intra-operative Fluorescence Vascular Angiography (IFVA) performed using the SPY system enables cardiac surgeons to evaluate native and bypass graft function, distal outflow and perfusion to the micro-vascular bed. IFVA may also be used to potentially more effectively locate and document regions of the micro-vascular myocardium that are not fully being adequately perfused by direct coronary bypass and may benefit from TMR.
Image guided surgical revascularization provides a greater opportunity for complete revascularization. The use of IFVA has been shown in clinical studies to reduce post-operative complications, repeat interventions, and peri-operative graft failures. IFVA is used to assess patency, address technical deficiencies and identify areas untreatable with bypass and therefore provide an 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.
The CO˛ Heart Laser System for TMR
TMR is an effective angina relief therapy for diffusely diseased coronary vessels with poor targets for bypass. CO2 technology (1000 watts) allows the Heart Laser System to create a channel in a single pulse. The CO2 Heart Laser's single pulse is synchronized with the heartbeat, firing only when the heart is at rest. This is the point at which the heart is at reduced risk of arrhythmia.
The CO2 Heart Laser's channels have been reported to maintain tissue integrity and foster healing. These channels stimulate measurable perfusion, when using TMR to treat areas of the heart that other methods of treatment cannot. The straight and clean channels may lay a foundation for vascular growth and provide long-lasting pain relief.
