Impact of preoperative fractional flow reserve on arterial bypass graft anastomotic function: the IMPAG trial

Abstract

Aims Visual estimation is the most commonly used method to evaluate the degree of coronary artery stenosis prior to coronary artery bypass grafting. In interventional cardiology, the use of fractional flow reserve (FFR) to guide revascularization decisions has become routine. We investigated whether the preoperative FFR measurement of coronary lesions is associated with anastomosis function 6 months after surgical revascularization using a multiarterial grafting strategy. Methods and results In this prospective double-blind study, 67 patients were enrolled from two institutions in Europe and Canada. From these patients, 199 coronary lesions were assessed visually and with FFR at the time of the preoperative angiogram. All patients received coronary revascularization using multiple arterial grafts. A post-operative 6-month angiogram was performed to assess anastomosis functionality using a described angiographic method. The primary outcome was the association between preoperative FFR values and anastomosis function 6 months after surgery. Preoperative FFR was significantly associated with 6-months anastomotic function for all conduits and for all targets (P < 0.001). An FFR value of ≤0.78 was associated with an anastomotic occlusion rate of 3%. Conclusion We found a significant association between the preoperative FFR measurement of the target vessel and the anastomotic functionality at 6 months, with a cut-off of 0.78. Integration of FFR measurement into the preoperative diagnostic workup before multiarterial coronary surgical revascularization leads to improved anastomotic graft function. Clinical Trials. gov Identifier NCT02527044.

Efficacy of Fractional Flow Reserve-Guided Percutaneous Cornary Intervention for Patients with Angina Pectoris

“…Moreover, previous studies have shown that FFR evaluation may be useful in determining the target vessels for surgical revascularization. 43,44) Assessment of the FFR should be considered when ischemia is suspected in the target lesions.…”

Fractional flow reserve guided coronary artery bypass grafting - new developments and future perspectives

“…The association of preoperative FFR on isolated total arterial CABG functionality 6 months postoperatively in patients with triple vessel disease were recently reported in the interim results of the IMPAG trial [35] as a 2-centre, single-arm, blinded study. The interim results of 63 patients (54 bilateral internal thoracic Y-graft configurations), included the evaluation of 199 arterial anastomoses, of which 135 were sequential anastomoses.…”

FFR‐guided versus coronary angiogram‐guided CABG: A review and meta‐analysis of prospective randomized controlled trials

“…All intermediate lesions should be assessed with FFR and those with FFR value greater than 0.80 should be deferred. Lesions with FFR < 0.80 should be split to two categories: (a) Lesions with FFR < 0.78 pose low risk of competitive flow and should be considered for total arterial grafting and (b) Lesions with FFR > 0.78 and <0.80 still pose a high risk of competitive flow and should receive a standard CABG procedure with left internal mammary artery and saphenous vein graft 18,19 …”