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Fractional Flow Reserve–Guided CABG: A Review
Study Questions:
What are the available data on fractional flow reserve (FFR)-based coronary artery bypass grafting (CABG) and the rationale and potential consequences of a switch towards FFR-based surgical revascularization strategy?
Methods:
The investigators performed a systematic review according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Search keywords included “fractional flow reserve,” “FFR” in combination with “CABG,” “myocardial surgical revascularization,” “coronary artery bypass,” and “coronary artery bypass grafting.”
Results:
Searches initially retrieved 1,695 records; after de-duplication and exclusion of nonpertinent papers, seven articles (reporting on a total of five studies [two randomized controlled trials and three observational studies] and 1,130 patients) met the inclusion criteria. Use of FFR was associated with simplified surgical procedures, but at 1-year follow-up, no difference in overall graft patency (80% vs. 81%, respectively; p = 0.885) or in the composite of death, myocardial infarction, target vessel revascularization, and stroke was found in the GRAft patency after FFR-guided versus angiography-guided CABG (GRAFFITI) trial.
Conclusions:
The authors concluded that 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.
Perspective:
This systemic review reports that preoperative use of FFR in patients undergoing CABG reduces the number of distal anastomoses and simplifies the CABG procedure, but there is no evidence that the use of FFR improves early clinical outcomes after CABG. Furthermore, the use of preoperative FFR may help in defining the indication to the use of arterial grafts without any benefits in terms of patency when venous grafts are used. A randomized prospective clinical trial in patients with multivessel disease and an angiographic indication for CABG randomized to angio-based or FFR-based CABG with enough power to detect clinically significant differences in short- and long-term clinical outcomes is indicated.
Clinical Topics: Cardiac Surgery, Cardiovascular Care Team, Invasive Cardiovascular Angiography and Intervention, Noninvasive Imaging, Prevention, Cardiac Surgery and Arrhythmias, Interventions and Imaging, Angiography, Nuclear Imaging
Keywords: Cardiac Surgical Procedures, Coronary Angiography, Coronary Artery Bypass, Fractional Flow Reserve, Myocardial, Myocardial Infarction, Myocardial Ischemia, Myocardial Revascularization, Secondary Prevention, Stroke
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