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. 2023 Sep;38(6):1230-1239.
doi: 10.1177/02676591221099808. Epub 2022 May 6.

Instantaneous wave free ratio value impact on left internal mammary artery graft patency

Rasa Ordiene  1 , Ramunas Unikas  1 , Ali Aldujeli  1 , Rimantas Benetis  2 , Povilas Jakuska  2 , Indre Ceponiene  3 , Antanas Jankauskas  3 , Jurgita Plisiene  1 , Tadas Lenkutis  2 , Gabriele Rudokaite  1 , Rima Braukyliene  1 , Mindaugas Stonis  4 , Justin Davies  5 , Prakash P Punjabi  6
Affiliations

Instantaneous wave free ratio value impact on left internal mammary artery graft patency

Rasa Ordiene et al. Perfusion. 2023 Sep.

Abstract

Objectives: To assess whether instantaneous wave - free ratio (iFR) value is associated with left internal mammary artery (LIMA) graft failure at 12 months follow-up post coronary artery bypass graft (CABG).

Background: Data suggests bypass to a non-significant left anterior descending artery (LAD) lesion due to visual over-estimation may lead to LIMA graft failure. Implementing iFR may result in better arterial graft patency.

Methods: In iCABG (iFR guided CABG) study patients planned to undergo an isolated CABG procedure was prospectively enrolled and iFR was performed for LAD. Coronary computed tomography angiography was performed at 2 and 12 months follow-up. The primary endpoint of this study was to determine the rate of LIMA graft occlusion or hypoperfusion at 2 and 12-months follow-up. We considered a composite secondary endpoint of Major adverse cardiovascular and cerebrovascular event (MACCE) as a secondary outcome.

Results: In total 69 patients were included with no differences regarding age, sex and risk factors. At 2 months, 50 of LIMAs with pre-CABG iFR median 0.855 (0.785 - 0.892) were patent. Hypoperfusion was found in 8 LIMAs (median iFR 0.88 (0.842 - 0.90)). While, 7 LIMAs (median iFR 0.91 (0.88 - 0.96)) were occluded (p = 0.04). At 12 months, when iFR of LAD was >0.85: just 12 (31.6% out of all patent LIMAS) grafts were patent and 24 (100.0% out of all hypoperfused/occluded) grafts were hypoperfused or occluded (p < 0.001). In terms of MACCE, no difference (p = 1.0) was found between all 3 groups divided according to iFR value.

Conclusions: Instantaneous wave - free ratio value above 0.85 in LAD is a powerful tool predicting LIMA graft failure at 1-year follow up period.

Keywords: instantaneous wave free ratio guided coronary artery bypass graft surgery; instantaneous wave – free ratio; left internal mammary artery failure.

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Conflict of interest statement

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
Design of the study. VD pts:multivessel disease patients; CABG: coronary artery bypass grafting; LM– left main; LAD– left anterior descending artery; iFR– instantaneous wave-free ratio; CT: computed tomography; MACCE: major adverse cardiac and cerebrovascular events.
Figure 2.
Figure 2.
Patients IFR of LAD box Plot by graft patency in 2 months. ×2 = 9.984, df = 2, p = 0.007, according to Kruskal-Wallis test, ap=0.004 *LAD: left anterior descending artery, iFR: instantaneous wave-free ratio
Figure 3.
Figure 3.
Patients IFR of LAD box Plot by graft patency in 12 months ×2 = 26,059, df = 2, p < 0.001, according to Kruskal-Wallis test, ab p < 0.001 *LAD: left anterior descending artery, iFR: instantaneous wave-free ratio.
Figure 4.
Figure 4.
Graft patency rate according to iFR value. *iFR – instantaneous wave free ratio; LAD – left anterior descending artery.
Figure 5.
Figure 5.
Receiver operating characteristic (ROC) test for LAD iFR threshold predicting dysfunction of LIMA graft according to 12 months CCTA graft patency: iFR value >0.85 in LAD Area under the ROC curve (AUC) 88.4%, sensitivity 100.0%, specificity 68.4%. *iFR: instantaneous wave free ratio; LAD: left anterior descending artery.
See this image and copyright information in PMC

References

    1. Balacumaraswami L, Taggart DP. Intraoperative imaging techniques to assess coronary artery bypass graft patency. Ann Thorac Surg 2007; 83(06): 2251–2257. - PubMed
    1. Gaudino M, Antoniades C, Benedetto U, et al. Mechanisms, Consequences, and prevention of coronary graft failure. Circulation 2017; 136: 1749–1764. DOI: 10.1161/CIRCULATIONAHA.117.027597 - DOI - PubMed
    1. Harskamp RE, Alexander JH, Ferguson TB, et al. Frequency and predictors of internal mammary artery graft failure and subsequent clinical outcomes. Circulation 2016; 133: 131–138. DOI: 10.1161/CIRCULATIONAHA.115.015549 - DOI - PMC - PubMed
    1. Otsuka F, Yahagi K, Sakakura K, et al. Why is the mammary artery so special and what protects it from atherosclerosis? Ann Cardiothora Surg 2013; 2: 519–526. DOI: 10.3978/j.issn.2225-319X.2013.07.06 - DOI - PMC - PubMed
    1. He G-W, Fan L, Grove KL, et al.. Expression and function of endothelial nitric oxide synthase messenger RNA and protein are higher in internal mammary than in radial arteries Ann Thorac Surg 2011; 92: 845–850. DOI: 10.1016/j.athoracsur.2011.04.063 - DOI - PubMed