Current Trends and Perspectives of Pressure Wire-Based Coronary Artery Bypass Grafting

Figures

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  Figure 1. Our current algorithm of FFR-guided revascularization for LAD with moderate stenosis. CAG: coronary angiography, LAD: left anterior descending artery, FFR: fractional flow reserve, MPS: myocardial perfusion scintigraphy, LITA: left internal thoracic artery, NT SVG: no-touch saphenous vein graft.

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  Figure 2. Annual trends in the number of patients who underwent FFR measurement before open-heart surgery at our institution. FFR: fractional flow reserve.

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  Figure 3. Influencing factors on application of FFR-guided CABG. FFR: fractional flow reserve, CABG: coronary artery bypass grafting.

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  Figure 4. NHPRs measured simultaneously with FFR before open-heart surgery by the end of May 2023 at our institute. NHPRs: non-hyperemic pressure ratios, FFR: fractional flow reserve.

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  Figure 5. As NHPRs, iFR pullback (A) and dPR pullback (B) provide a trans-stenotic pressure gradient for each lesion in cases of tandem lesions. (A) A 75-year-old male patient, who was scheduled for aortic valve replacement due to aortic valve stenosis, showed 75% stenosis in the left circumflex artery on coronary angiography. To determine the need for revascularization, he underwent both FFR and pullback iFR measurements. The iFR values were >0.89 at all points, and the FFR was 0.84. Therefore, the lesion was deferred, and revascularization was not indicated. (B) A 73-year-old male patient presented with 75% stenosis in the left anterior descending (LAD) artery. He underwent both FFR and pullback dPR measurements. The dPR values gradually decreased (<0.89) as they were measured distally. The FFR was 0.58. Therefore, revascularization of the LAD was performed. NHPRs: non-hyperemic pressure ratios, iFR: instantaneous wave-free ratio, dPR: diastolic pressure ratio, LAD: left anterior descending artery.

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  Figure 6. Quantitative computed tomographic coronary angiography (CTCA) (A), three-dimensional CTCA image (B), and fractional flow reserve (FFR-CT) measurement (C) in a 78-year-old male patient before surgery for a thoracic aortic aneurysm show moderate coronary lesions (50–70% lumen narrowing by visual CTCA) with partly calcified plaques in the right coronary artery (RCA) and left anterior descending artery (LAD). The RCA showed an FFR-CT value of 0.72 and was therefore grafted, whereas the LAD showed an FFR-CT value of 0.89 and was deferred.