Fractional flow reserve to guide and to assess coronary artery bypass grafting. 2017

Mariano Pellicano, and Bernard De Bruyne, and Gabor G Toth, and Filip Casselman, and William Wijns, and Emanuele Barbato
Cardiovascular Research Center Aalst, OLV Clinic, Moorselbaan n 164, B 9300 Aalst, Belgium.

The aim of this review is to highlight the role of invasive functional evaluation in patients in whom coronary artery bypass graft (CABG) is indicated, and to examine the clinical evidence available in favour of fractional flow reserve (FFR) adoption in these patients, outline appropriate use, as well as point out potential pitfalls. FFR after CABG will also be reviewed, highlighting its correct interpretation and adoption when applied to both native coronary arteries and bypass grafts. Practice European guidelines support the use of FFR to complement coronary angiography with the highest degree of recommendation (Class IA) for the assessment of coronary stenosis before undertaking myocardial revascularization when previous non-invasive functional evaluation is unavailable or not conclusive. As a result, FFR has been adopted in routine clinical practice to guide clinicians decision as to whether or not perform a revascularization. Of note, due to the increasing confidence of the interventional cardiologists, FFR guidance is also being implemented to indicate or guide CABG. This is in anticipation of supportive clear-cut evidence, since recommendations for FFR adoption were based on randomized clinical trials investigating percutaneous coronary intervention (PCI) strategies in which patients with typical indications for CABG were excluded (e.g. left main disease, valvular disease, and coronary anatomy unsuitable for PCI). Based on the critical appraisal of the literature, FFR can play an important role in risk stratification and determining management strategy of patients either before or after CABG.

UI MeSH Term Description Entries
D009204 Myocardial Revascularization The restoration of blood supply to the myocardium. (From Dorland, 28th ed) Internal Mammary Artery Implantation,Myocardial Revascularizations,Revascularization, Myocardial,Revascularizations, Myocardial
D003324 Coronary Artery Disease Pathological processes of CORONARY ARTERIES that may derive from a congenital abnormality, atherosclerotic, or non-atherosclerotic cause. Arteriosclerosis, Coronary,Atherosclerosis, Coronary,Coronary Arteriosclerosis,Coronary Atherosclerosis,Left Main Coronary Artery Disease,Left Main Coronary Disease,Left Main Disease,Arterioscleroses, Coronary,Artery Disease, Coronary,Artery Diseases, Coronary,Atheroscleroses, Coronary,Coronary Arterioscleroses,Coronary Artery Diseases,Coronary Atheroscleroses,Left Main Diseases
D006349 Heart Valve Diseases Pathological conditions involving any of the various HEART VALVES and the associated structures (PAPILLARY MUSCLES and CHORDAE TENDINEAE). Heart Valvular Disease,Valvular Heart Diseases,Disease, Heart Valvular,Heart Disease, Valvular,Heart Valve Disease,Heart Valvular Diseases,Valve Disease, Heart,Valvular Disease, Heart,Valvular Heart Disease
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D001026 Coronary Artery Bypass Surgical therapy of ischemic coronary artery disease achieved by grafting a section of saphenous vein, internal mammary artery, or other substitute between the aorta and the obstructed coronary artery distal to the obstructive lesion. Aortocoronary Bypass,Bypass, Coronary Artery,Bypass Surgery, Coronary Artery,Coronary Artery Bypass Grafting,Coronary Artery Bypass Surgery,Aortocoronary Bypasses,Artery Bypass, Coronary,Artery Bypasses, Coronary,Bypass, Aortocoronary,Bypasses, Aortocoronary,Bypasses, Coronary Artery,Coronary Artery Bypasses
D053805 Fractional Flow Reserve, Myocardial The ratio of maximum blood flow to the MYOCARDIUM with CORONARY STENOSIS present, to the maximum equivalent blood flow without stenosis. The measurement is commonly used to verify borderline stenosis of CORONARY ARTERIES. Myocardial Fractional Flow Reserve
D054059 Coronary Occlusion Complete blockage of blood flow through one of the CORONARY ARTERIES, usually from CORONARY ATHEROSCLEROSIS. Coronary Occlusions,Occlusion, Coronary,Occlusions, Coronary
D062645 Percutaneous Coronary Intervention A family of percutaneous techniques that are used to manage CORONARY OCCLUSION, including standard balloon angioplasty (PERCUTANEOUS TRANSLUMINAL CORONARY ANGIOPLASTY), the placement of intracoronary STENTS, and atheroablative technologies (e.g., ATHERECTOMY; ENDARTERECTOMY; THROMBECTOMY; PERCUTANEOUS TRANSLUMINAL LASER ANGIOPLASTY). PTCA was the dominant form of PCI, before the widespread use of stenting. Percutaneous Coronary Revascularization,Coronary Intervention, Percutaneous,Coronary Interventions, Percutaneous,Coronary Revascularization, Percutaneous,Coronary Revascularizations, Percutaneous,Intervention, Percutaneous Coronary,Interventions, Percutaneous Coronary,Percutaneous Coronary Interventions,Percutaneous Coronary Revascularizations,Revascularization, Percutaneous Coronary,Revascularizations, Percutaneous Coronary
D023921 Coronary Stenosis Narrowing or constriction of a coronary artery. Coronary Artery Stenosis,Coronary Stenoses,Artery Stenoses, Coronary,Artery Stenosis, Coronary,Coronary Artery Stenoses,Stenoses, Coronary,Stenoses, Coronary Artery,Stenosis, Coronary,Stenosis, Coronary Artery

Related Publications

Mariano Pellicano, and Bernard De Bruyne, and Gabor G Toth, and Filip Casselman, and William Wijns, and Emanuele Barbato
May 2020, JACC. Cardiovascular interventions,
Mariano Pellicano, and Bernard De Bruyne, and Gabor G Toth, and Filip Casselman, and William Wijns, and Emanuele Barbato
December 2018, Journal of the American College of Cardiology,
Mariano Pellicano, and Bernard De Bruyne, and Gabor G Toth, and Filip Casselman, and William Wijns, and Emanuele Barbato
October 2013, The Journal of thoracic and cardiovascular surgery,
Mariano Pellicano, and Bernard De Bruyne, and Gabor G Toth, and Filip Casselman, and William Wijns, and Emanuele Barbato
November 2017, The Journal of thoracic and cardiovascular surgery,
Mariano Pellicano, and Bernard De Bruyne, and Gabor G Toth, and Filip Casselman, and William Wijns, and Emanuele Barbato
September 2018, The Journal of thoracic and cardiovascular surgery,
Mariano Pellicano, and Bernard De Bruyne, and Gabor G Toth, and Filip Casselman, and William Wijns, and Emanuele Barbato
November 2021, General thoracic and cardiovascular surgery,
Mariano Pellicano, and Bernard De Bruyne, and Gabor G Toth, and Filip Casselman, and William Wijns, and Emanuele Barbato
October 2020, Circulation,
Mariano Pellicano, and Bernard De Bruyne, and Gabor G Toth, and Filip Casselman, and William Wijns, and Emanuele Barbato
January 2013, Circulation journal : official journal of the Japanese Circulation Society,
Mariano Pellicano, and Bernard De Bruyne, and Gabor G Toth, and Filip Casselman, and William Wijns, and Emanuele Barbato
November 2000, Circulation,
Mariano Pellicano, and Bernard De Bruyne, and Gabor G Toth, and Filip Casselman, and William Wijns, and Emanuele Barbato
April 2017, Journal of thoracic disease,
Copied contents to your clipboard!