Our Summary

This research paper discusses the evolution of identifying significant lesions or blockages in the blood vessels of the heart. Over the last decade, a method called fractional flow reserve (FFR) has been increasingly used to determine the severity of these blockages and is proving to be better than the previously used methods.

This FFR method is currently used in a procedure called percutaneous revascularization, where a small balloon is used to open up the blockages in the blood vessels. The study suggests that this approach has led to safer and more efficient procedures with better results for the patient.

However, the use of FFR is not yet common in surgical revascularization procedures, specifically in coronary artery bypass grafting (CABG), a type of open heart surgery. The paper explores the potential benefits of using FFR in CABG procedures, such as less complicated surgeries, shorter operating times, and potentially better outcomes for the patient.

In essence, the paper discusses the potential of FFR-guided therapy in improving the standard of care in heart surgeries and where the field might be headed in the future.

FAQs

  1. What is Fractional Flow Reserve (FFR) and how is it used in the field of percutaneous revascularization?
  2. Could the use of FFR-guided Coronary Artery Bypass Grafting (CABG) potentially lead to less complicated procedures and better cardiovascular outcomes?
  3. What is the current standard of practice in relation to CABG and how might the use of FFR change this?

Doctor’s Tip

One helpful tip a doctor might tell a patient about CABG is that the use of fractional flow reserve (FFR) can help determine the severity of blockages in the coronary arteries and guide the decision-making process for revascularization. By utilizing FFR-guided therapy, doctors can identify which lesions are causing ischemia and prioritize treatment for those specific areas, potentially leading to better outcomes and reducing the need for unnecessary procedures. It is important for patients to discuss the use of FFR with their doctor to ensure they are receiving the most effective and personalized treatment plan for their condition.

Suitable For

Patients who are typically recommended for coronary artery bypass grafting (CABG) are those with significant coronary artery disease, which may include:

  1. Patients with left main coronary artery disease
  2. Patients with three-vessel disease
  3. Patients with two-vessel disease involving the proximal left anterior descending artery
  4. Patients with severe angina or unstable angina not responding to medical therapy
  5. Patients with significant stenosis in multiple coronary arteries
  6. Patients with diabetes and multivessel disease

It is important for patients to undergo thorough evaluation by a cardiologist and a cardiac surgeon to determine if CABG is the most appropriate treatment option for their specific condition.

Timeline

Before CABG:

  1. Patient presents with symptoms of angina or other signs of coronary artery disease.
  2. Patient undergoes diagnostic testing such as coronary angiography to determine the extent and location of blockages in the coronary arteries.
  3. Based on the results of the diagnostic testing, the decision is made to proceed with CABG as the best treatment option.

After CABG:

  1. Patient undergoes pre-operative assessment, including evaluation of comorbidities and risk factors.
  2. Patient undergoes CABG surgery, during which the blocked coronary arteries are bypassed using grafts from other parts of the body.
  3. Post-operatively, the patient is monitored in the intensive care unit for a period of time to ensure stability and recovery.
  4. Patient undergoes rehabilitation and recovery process, including cardiac rehabilitation and lifestyle modifications to improve long-term outcomes.
  5. Follow-up appointments are scheduled to monitor progress and adjust medications as needed.

What to Ask Your Doctor

  1. What is fractional flow reserve (FFR) and how is it used in determining the need for coronary artery bypass grafting (CABG)?
  2. How does FFR-guided CABG differ from traditional angiography-guided CABG?
  3. What are the potential benefits of FFR-guided CABG in terms of procedural complications, operating time, and outcomes?
  4. Are there specific criteria or guidelines for determining when FFR-guided CABG is appropriate for a patient?
  5. How does FFR-guided CABG impact the decision-making process for selecting on-pump vs. off-pump CABG procedures?
  6. Are there any potential risks or limitations associated with FFR-guided CABG compared to traditional CABG techniques?
  7. What are the current trends and future directions in the use of FFR-guided CABG in clinical practice?
  8. Are there any ongoing research studies or clinical trials evaluating the efficacy and safety of FFR-guided CABG?

Reference

Authors: Ahmadi A, Stanger D, Puskas J, Taggart D, Chandrashekhar Y, Narula J. Journal: Ann Cardiothorac Surg. 2018 Jul;7(4):546-551. doi: 10.21037/acs.2018.07.01. PMID: 30094220