Cardiac Surgery

SPY Imaging in Cardiac Surgery

Nearly 400,000 Americans undergo coronary artery bypass surgery, also known as “CABG”, each year.  CABG is performed to treat blockages in coronary arteries that are typically caused by fatty build up or “atherosclerotic plaque” that develops on the vessel walls.  Blockages interfere with normal blood flow to the heart muscle, often resulting in patient symptoms such as excessive sweating, left arm, jaw or chest pain.  As blockages become more severe, they can lead to irregular heart rhythms, heart attack or “myocardial infarction” and in the worst cases, sudden death. During the performance of CABG, surgeons typically use a vessel from the chest wall and/ or the lower leg to create a “detour” or bypass for blood to flow from the aorta to the native coronary artery past the location of the blockage. Bypass grafts are intended to restore adequate blood flow or “perfusion” to the heart muscle.

SPY Fluorescence Imaging technology enables surgeons to treat every patient as a unique individual and to perform the most optimal procedure for that specific person. During CABG surgery, SPY allows cardiac surgeons to visually assess the quality of blood flow in native coronary arteries, bypass grafts and the micro-vessels supplying blood to myocardial tissue while in the operating room. If, during the course of creating the bypass grafts, the surgeon observes that blood flow has not been optimally restored, the surgeon can decide if revisions to the grafts should be performed. SPY imaging is the only method that allows surgeons to see blood flow in coronary vessels and tissue during the operation and to make modifications to optimize revascularization during the operation. SPY imaging does not involve ionizing radiation or nephrotoxicity, which potentially can be harmful to some patients.

SPY imaging has been the topic of a substantial body of evidence supporting its use in CABG surgery.  In 2009, cardiac surgeon researchers presented results from 350 patients undergoing CABG including SPY imaging enrolled in the VICTORIA Multicenter Registry. VICTORIA data showed that the complication rates, including reoperation and long length of stay, were 50% lower than expected compared to similar patients enrolled in the Society of Thoracic Surgeon’s (STS) national cardiac database. The STS database is one of the longest standing and largest existing medical data sets that exists today.

The Centers for Medicare and Medicaid independently studied cost data in 2008 and 2009, and concluded that the use of SPY in CABG resulted in average cost reductions of $2,000 – $4,000 per patient. In today’s healthcare environment, cost savings resulting from reductions in complications are critical to achieving the goals of healthcare reform. Medicare established ICD-9-code 88.59 to describe the use of SPY in coronary artery bypass surgery.

A Sentara Heart Hospital independent study of more than 700 patients undergoing CABG demonstrated that total costs of CABG were 4.2% lower and average length of stay 6-16% lower in 358 patients where the CABG procedure included SPY Imaging versus the 225 cases performed without SPY.


1. Ferguson, TB et al., Intra-operative Angiography in CABG as a Quality Metric: The Victoria Registry, poster presented at the American Heart Association Meeting, November 2009.

2. DEPARTMENT OF HEALTH AND HUMAN SERVICES, Centers for Medicare & Medicaid Services 42 CFR Parts 412, 413, 415, and 489, [CMS-1406-P] RIN 0938-AP39, Medicare Program; Proposed Changes to the Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and Fiscal Year 2010 Rates and to the Long-Term Care Hospital Prospective Payment System and Rate Year 2010 Rates, Sept. 2009.


3. Data on File at Sentara Heart Hospital and NOVADAQ