Comparative Diagnostic Performance and Clinical Effectiveness of Intraoperative Quality Control Modalities in Coronary Revascularization: A Systematic Review and Aggregate Comparative Analysis of Real-World Evidence

Background:Intraoperative graft assessment during coronary artery bypass grafting (CABG) aims to identify technical anastomotic defects before chest closure. Transit-time flow measurement (TTFM) and indocyanine green (ICG) fluorescence imaging represent complementary intraoperative assessment modalities, yet their comparative diagnostic performance against angiographic reference standards remains incompletely defined.

Methods

PubMed, Scopus, Web of Science Core Collection, and CENTRAL were searched from January 2000 to February 2026 using terms for CABG, ICG, and TTFM; duplicate screening yielded κ = 0.86–0.91. Eligible studies evaluated ICG and/or TTFM against invasive coronary angiography or computed tomography coronary angiography. Methodological quality was appraised using QUADAS-2 for diagnostic cohorts and the Newcastle-Ottawa Scale (NOS) for clinical-utility cohorts. Because only three directly comparable cohorts provided sufficiently reliable paired 2×2 data, formal bivariate random-effects meta-analysis was not performed. Verified 2×2 contingency data were summarised descriptively with exact Clopper–Pearson 95% confidence intervals. Clinical-utility evidence was synthesised narratively.