State-of-the-Art Review
Fractional Flow Reserve–Based Coronary Artery Bypass Surgery: Current Evidence and Future Directions

https://doi.org/10.1016/j.jcin.2019.12.017Get rights and content
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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.

Key Words

CABG
FFR
myocardial revascularization

Abbreviations and Acronyms

CABG
coronary artery bypass grafting
CI
confidence interval
FFR
fractional flow reserve
HR
hazard ratio
ITA
internal thoracic artery
LAD
left anterior descending artery
LITA
left internal thoracic artery
PCI
percutaneous coronary intervention
PRISMA
Preferred Reporting Items for Systematic Reviews and Meta-Analyses
RA
radial artery
SVG
saphenous vein graft

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Dr. Barbato has received speaker fees from Boston Scientific, Abbott Vascular, and GE. Dr. Oldroyd has served as a consultant for and received speaker fees from Abbott Vascular and Biosensors. Dr. Fremes has received grant support in part by the Bernard S Goldman Chair in Cardiovascular Surgery. Dr. Angiolillo has received consulting fees or honoraria from Amgen, Aralez, AstraZeneca, Bayer, Biosensors, Boehringer Ingelheim, Bristol-Myers Squibb, Chiesi, Daiichi-Sankyo, Eli Lilly, Haemonetics, Janssen, Merck, PhaseBio, PLx Pharma, Pfizer, Sanofi, and The Medicines Company; has served as a consultant for CeloNova and St. Jude Medical; and has received institutional grant support from Amgen, AstraZeneca, Bayer, Biosensors, CeloNova, CSL Behring, Daiichi-Sankyo, Eisai, Eli Lilly, Gilead, Idorsia, Janssen, Matsutani Chemical Industry Co., Merck, Novartis, Osprey Medical, and Renal Guard Solutions. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

The authors attest they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the JACC: Cardiovascular Interventions author instructions page.

Drs. Spadaccio and Glineur contributed equally to this work.