A Coordinator's Report

SPY Enables Complex Procedures, Increases Confidence in Outcomes and Confirms Surgical Leadership

In 1967, a Russian surgeon by the name of Kolessov, performed the first beating heart coronary bypass graft procedure using the Left Internal Mammary Artery (LIMA) to bypass the Left Anterior Descending (LAD). A year later, Dr. Rene Favaloro popularized the LIMA to LAD procedure and since then, over 300,000 coronary artery bypass graft (CABG) procedures are performed in the United States each year. A great majority of these procedures involve a LIMA to LAD graft. Literature has shown that a patent LIMA to LAD graft is one of the strongest predictors of long term survival. Although the LIMA to LAD techniques are widely accepted, only approximately 25% of all CABG cases are performed on a beating heart and without the use of the cardiopulmonary bypass machine. These procedures, commonly known as “off -pump” CABG or OPCAB, have been shown to benefit patients by reducing the length of time in the ICU, the need for ventilation support, neuro-cognitive complications and overall hospital stay. Obviously these post-operative improvements can result in cost savings for hospitals. Although like us, there are strong believers in beating heart CABG, debates continue as to which bypass technique, off- pump vs on-pump, is more efficacious. Claims that the quality of grafts in off pump procedures are inferior compared to those performed while on pump, are common. However, unless you actually do something to confirm graft patency, how would one really know?

In an age where patients are well informed and actively participate in deciding the type of health care they prefer, it has become imperative to be able to offer the latest technology and to provide the best care possible. Competition between providers in the health care industry has become fierce and is a major factor in how well an institution strives to perform. Today, we are not only required to provide the highest quality of care, but we must prove to our community, both physicians and patients alike, that we offer the very best. Outcomes of procedures are constantly measured and in many instances, are in public records.

In our institution, we believe that performing off-pump CABG procedures offers the best benefits to patients, and thanks to the SPY Imaging System, we are able to prove that our grafts are open and functioning, well before the patient leaves the operating room. A picture is worth a thousand words and in the case of SPY, it is even more. SPY gives us the confidence to perform more beating heart procedures, and since SPY images are performed in real time in the OR, our surgeons are able to better assess the immediate benefits of the operation and to decide when an adjunctive therapy, such as TMR, might be of benefit.

SPY is easy to use, and image capture adds very little time to the operative procedure, which is why our staff has embraced it. The learning curve is almost non-existent thanks to the clinical support Novadaq provides. Our staff members take pride in using SPY, because the images confirm in our minds, everyday, that we are providing the best possible care for CABG patients. We also believe that SPY is one of the few new procedures that essentially has a zero % deleterious effect on either patients or staff and provides benefit 100% of the time. There is no radiation involved and unlike other contrast materials, the imaging agent is non-toxic.

In our institution, SPY images are included in the charts of every patient who receives a CABG procedure. Every patient sees their images, which increases their confidence in us and the quality of their procedure. Although we also measure the blood flow through grafts during CABG in our hospital, it is really the real-time visual image that guides and verifies the integrity of the procedure. It offers significant reassurance to both referring physicians and patients at a very reasonable cost. Since we use SPY in every case, there can be no question that the grafts we create in our off-pump CABG procedures are patent and functioning properly. SPY-Q further enables us to know that we have provided adequate blood flow to the myocardium which is critical to ensuring long term success.

Beating heart CABG combined with SPY Imaging gives us a competitive advantage over other heart programs in our area. Ultimately, it is the patient who benefits the most from having received and knowing they’ve received the best.

- Pablo Zubiate, CVS coordinator, Stamford Hospital 

In 2008, Pablo Zubiate left his home in California and joined his long time friend and colleague Dr. Li Poa at the Stamford Hospital in Stamford, Connecticut where Dr. Poa was charged with starting a new heart surgery program. Pablo is now the Cardiovascular Surgical Coordinator at Stamford which is an affiliate of the Columbia University-College of Physicians & Surgeons and a member of the New York-Presbyterian Healthcare System. Stamford Hospital performed approximately 170 cardiac surgery procedures during its first year of operation and is expecting to increase that volume year after year.
Pablo has been a perfusionist for more than 20 years. In his current role, Pablo manages a staff of cardiac health care professionals, including 3 perfusionists and 6 registered nurses, each committed to the use of the SPY to improve quality outcomes. Pablo’s staff is quite proficient at the operation of SPY and are now also implementing the imaging analysis provided by SPY-Q. Stamford Hospital has recently joined the VICTORIA Registry.
Prior to joining the team at Stamford, Pablo was a manager within the cardiac surgery department at Enloe Hospital in Chico, California where he again worked with Dr. Poa. Enloe was one of the first hospitals to utilize the SPY in the United States and one of the largest contributors to the VICTORIA Registry. Pablo was educated as a perfusionist at the University of Southern California.