NON-INVASIVE QUANTIFICATION OF BLOOD FLOW IN EPICARDIAL CORONARY ARTERIES, CORONARY ARTERY BYPASS GRAFTS, AND ANASTOMOSES
Thomas B. Ferguson, Jr.1, Cheng Chen, PhD1, Kenneth Jacobs, PhD1, Zhiyong Peng, PhD1, Jeffery Basham2.
1East Carolina Heart Institute, Greenville, NC, USA, 2RFPi, LLC, Greenville, NC, USA.
OBJECTIVE: Clinical and experimental approaches to directly measure flow in epicardial coronary arteries, coronary bypass grafts, and anastomoses are severely limited by the invasiveness and inaccuracy of existing technologies. As a result, < 25% of patients undergoing CABG worldwide have any intraoperative evaluation performed. The advent of a simple, accurate and non-invasive technology to directly quantify blood flow in conduits and rheology at anastomotic sites would provide intraoperative quality documentation and new physiologic information that would improve outcomes.
METHODS: The fact that existing technologies are unable to meet this demand necessitated a different technology solution. Using an optical physics approach, flow in conduits and tissue can be quantified in real time with non-ionizing broad-spectrum imaging and temporal and spatial analyses. In particular, cardiac motion must be addressed so that flow can be quantified at any point throughout the cardiac cycle.
RESULTS: This new, proprietary and patented technology is demonstrated in the FIGURE in an established porcine cardiac experimental model. Flow velocities and flow in the mid-distal left anterior descending coronary artery (white box) vary with the cardiac cycle. The quantified change in flow velocity in the mid-distal LAD is shown by the blue curve within each cardiac cycle and at end-systole (middle panel) and end-diastole (right panel). These imaging data are captured, analyzed and displayed in real-time as a video from a viewing distance of 30 cm. The field of view of is 9 cm x 9 cm, large enough to capture flow in the proximal and distal epicardial coronary, the conduit, and at the anastomosis simultaneously.
CONCLUSIONS: The rheologic interaction between conduit flow and native coronary flow at the anastomosis remains the most poorly understood aspect of coronary artery bypass grafting. A non-invasive, non-contact, no-risk imaging technology as simple as a snapshot can provide this critical physiologic information, validate and document intraoperative quality, and improve even further CABG outcomes.
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