Novadaq has developed SPY, the first imaging system for intra-operative fluorescence vascular angiography. SPY enables cardiac and plastic surgeons to assess the vasculature to confirm the location of target vessels and assess perfuser and bypass graft function during the course of coronary artery bypass procedures and flap grafts.

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The SPY Imaging System allows cardiac surgeons to capture, review, print and archive high-quality image sequences of coronary arteries, in real-time during a CABG procedure. Use of SPY enables cardiac surgeons to visually assess coronary circulation and confirm the quality of bypass grafts performed during surgery. Surgeons can use SPY pre-bypass to confirm their operative plan and intra-operatively to determine the need for any technical revisions to the bypass grafts. This may reduce post-operative complications and eliminate the need to make any repeat surgeries or other post-operative interventions.

Before SPY, there was no practical, routine method of visually assessing coronary artery circulation or bypass graft quality during CABG surgery. X-ray angiography is not practical in the cardiac operating room due to safety concerns related to radiation and the extra time and equipment required to perform the procedure. The SPY procedure does not involve radiation, which eliminates many safety concerns and can be accomplished without adding a significant amount of time to the surgical procedure or the need for additional personnel.

Approximately 10-20% of all CABG patients experience complications post-surgery, ranging from myocardial injury (MI) to death, as a result of poorly or non-functioning grafts. One recent study of more than 2,300 patients concluded that the use of SPY during CABG surgery in a subset of patients resulted in a significant 9% reduction in post-operative MI compared to those procedures not involving SPY imaging. In addition, it has been reported that approximately 9% of the more than 700,000 patients throughout the world who undergo CABG each year will require a second surgery or will return to the catheterization laboratory to address poorly functioning grafts. Repeat surgeries are associated with significantly increased risk of serious complications including death. The ability to better detect poorly functioning grafts in real-time in the operating room during the initial CABG procedure may eliminate the need for some of these risky and expensive additional procedures.

Visual intra-operative imaging and assessment is an opportunity to evolve cardiac surgery to a new standard of procedural effectiveness.  Intra-operative fluorescence vascular angiography with the SPY® Intra-operative Imaging System enables surgeons to confirm the location of target vessels in real time, assess native and bypass graft functionality, evaluate distal outflow and confirm perfusion to the coronary bed.

The consensus of early adopters is that the full opportunity for intra-operative imaging as applied to cardiac surgery has not yet been fully realised.

SPY Imaging Results in Quality Improvements in CABG

SPY Imaging allows cardiac surgeons to visually assess the quality of blood flow in coronary vessels and myocardial perfusion during the course of the CABG procedure. SPY provides surgeons with clinically relevant information that may help the surgeon to make better informed decisions, eliminate the potential for costly post-operative complications and the need for repeat surgery.

Before SPY, there was no practical, routine method of visually assessing bypass graft quality during CABG surgery. Although x-ray angiography is the gold standard, it is often not practical in the cardiac operating room due to safety concerns related to radiation and the extra time and equipment required to perform the procedure. The SPY procedure does not involve ionizing radiation, which eliminates many safety concerns and can be accomplished without adding a significant amount of time to the surgical procedure or the need for additional personnel.

Use of SPY Imaging, in cardiac surgery alone has been the subject of more than 20 peer-reviewed journal articles. Reports published in 2005 and in 2009, showed a 97% correlation between SPY images and x-ray angiography. Another recent study of more than 2,300 patients concluded that the use of SPY during CABG resulted in a significant 42% reduction of peri-operative Myocardial injury compared to those procedures not involving SPY. Myocardial infarction has been shown to significantly lengthen hospital stays and increase the cost of caring for CABG patients.