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. 2020 May 11;13(9):1086-1096.
doi: 10.1016/j.jcin.2019.12.017. Epub 2020 Mar 25.

Fractional Flow Reserve-Based Coronary Artery Bypass Surgery: Current Evidence and Future Directions

Cristiano Spadaccio  1 , David Glineur  2 , Emanuele Barbato  3 , Antonino Di Franco  4 , Keith G Oldroyd  5 , Giuseppe Biondi-Zoccai  6 , Filippo Crea  7 , Stephen E Fremes  8 , Dominick J Angiolillo  9 , Mario Gaudino  10
Affiliations

Fractional Flow Reserve-Based Coronary Artery Bypass Surgery: Current Evidence and Future Directions

Cristiano Spadaccio et al. JACC Cardiovasc Interv. .

Abstract

Fractional flow reserve (FFR) provides an objective measurement of the severity of ischemia caused by coronary stenoses in downstream myocardial regions. Data from the interventional cardiology realm have suggested benefits of a FFR-guided percutaneous coronary intervention (PCI) strategy. Limited evidence is available on the use of FFR to guide coronary artery bypass grafting (CABG). The most recent data have shown that FFR might simplify CABG procedures and optimize patency of arterial grafts without any clear impact on clinical outcomes. The aim of this review was to summarize the available data on FFR-based CABG and discuss the rationale and potential consequences of a switch toward FFR-based surgical revascularization strategy.

Keywords: CABG; FFR; myocardial revascularization.

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Figures

Figure 1.
Figure 1.
Mechanisms of flow competition. As shown, the relative contribution of the graft and of the native circulation to distal perfusion is inversely proportional to their resistance with competitive flow occurring when the resistance of the graft closely matches that of the stenosed native coronary artery. FFR, fractional flow reserve; ITA, internal thoracic artery; Pa, aortic pressure; Pd distal coronary pressure; Pv, right atrial pressure; SVG saphenous vein graft.
Figure 2.
Figure 2.
Potential reduction in graft dysfunction with FFR. The size of circles represents the study population. The percentage of arterial grafts in the study are plotted on the x-axis and absolute percentage risk reduction using FFR on the y-axis (modified from Eur Heart J. 2019. doi: 10.1093/eurheartj/ehz371.)
Central Illustration.
Central Illustration.
Proposed algorithm for FFR use in CABG patients. CABG, coronary artery bypass; CAD, coronary artery disease; FFR, fractional flow reserve; ITA, internal thoracic artery.
See this image and copyright information in PMC

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References

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