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

Cristiano Spadaccio; David Glineur; Emanuele Barbato; Antonino Di Franco; Keith G Oldroyd; Giuseppe Biondi-Zoccai; Filippo Crea; Stephen E Fremes; Dominick J Angiolillo; Mario Gaudino

doi:10.1016/j.jcin.2019.12.017

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

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

Authors

Affiliations

¹ Department of Cardiothoracic Surgery, Golden Jubilee National Hospital, Glasgow, United Kingdom.
² Division of Cardiac Surgery, University of Ottawa, Ottawa, Ontario, Canada.
³ Department of Advanced Biomedical Sciences, University of Naples Federico II, Napoli, Italy.
⁴ Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, New York.
⁵ West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow, United Kingdom.
⁶ Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Rome, Italy; Mediterranea Cardiocentro, Napoli, Italy.
⁷ Department of Cardiovascular and Thoracic Sciences, IRCCS Fondazione Policlinico Universitario A. Gemelli, Rome, Italy.
⁸ Schulich Heart Centre, Division of Cardiac Surgery, Department of Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada.
⁹ Department of Cardiology, University of Florida College of Medicine, Jacksonville, Florida.
¹⁰ Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, New York. Electronic address: mfg9004@med.cornell.edu.

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.

Publication types

Systematic Review

MeSH terms

Cardiac Catheterization*
Coronary Angiography
Coronary Artery Bypass* / adverse effects
Coronary Artery Disease / diagnosis*
Coronary Artery Disease / physiopathology
Coronary Artery Disease / surgery*
Fractional Flow Reserve, Myocardial*
Humans
Predictive Value of Tests
Treatment Outcome
Vascular Patency

Grants and funding

R01 HL152021/HL/NHLBI NIH HHS/United States