Impact of target coronary artery stenosis severity measured by instantaneous wave-free ratio on to bypassed graft patency

Almas Tolegenuly 1 2 * , Arslan Mamedov 1, Rimantas Benetis 1
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1 Department of Cardiac, Thoracic and Vascular Surgery, Hospital of Lithuanian University of Health Sciences Kauno Klinikos, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
2 Department of Cardiac Surgery, National Scientific Medical Center, Nur-Sultan city, Republic of Kazakhstan
* Corresponding Author
J CLIN MED KAZ, Volume 18, Issue 3, pp. 46-51. https://doi.org/10.23950/jcmk/10922
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ABSTRACT

Background: This study aimed to assess the impact of the measurement of the degree of target coronary artery stenosis using the instantaneous wave-free ratio (iFR) on patency of attached grafts.
Materials and Methods: A total of 86 grafts were assessed by computed tomography angiography (CTA) after coronary artery bypass grafting (CABG) in 24 patients with multivessel coronary artery disease (CAD). The iFR was evaluated for all target coronary arteries. The coronary artery stenoses were divided into three groups based on the iFR value: iFR < 0.86 (group 1); iFR 0.86–0.90 (group 2); and iFR > 0.90 (group 3).
Results: CTA was performed at 192 ± 44 days (range: 80–318 days). The correlation coefficient (r) between iFR and failed grafts was 0.332 (p = 0.035). Graft failure was detected in three grafts (8.1%) for group 1, in two grafts (8.3 %) for group 2, and in four grafts (16%, all arterial grafts) for group 3. Statistically significant differences were found between groups 1 and 3 (p = 0.041) and between groups 2 and 3 (p = 0.044). No significant differences were found between groups 1 and 2 (p = 0.228).
Conclusions: The degree of coronary artery stenosis measured by iFR is a risk factor for attached graft failure. In a coronary artery where the iFR was haemodynamically non-significant, a higher rate of graft failure was detected.
Keywords: coronary artery bypass grafting, instantaneous wave-free ratio, graft failure, computed tomography angiography

CITATION

Tolegenuly A, Mamedov A, Benetis R. Impact of target coronary artery stenosis severity measured by instantaneous wave-free ratio on to bypassed graft patency. J CLIN MED KAZ. 2021;18(3):46-51. https://doi.org/10.23950/jcmk/10922

REFERENCES

  • C. W. White et al., “Does Visual Interpretation of the Coronary Arteriogram Predict the Physiologic Importance of a Coronary Stenosis?,” N. Engl. J. Med., vol. 310, no. 13, pp. 819–824, Mar. 1984, doi: 10.1056/NEJM198403293101304.
  • S. Sen et al., “Development and validation of a new adenosine-independent index of stenosis severity from coronary waveintensity analysis: Results of the ADVISE (ADenosine Vasodilator Independent Stenosis Evaluation) study,” J. Am. Coll. Cardiol., vol. 59, no. 15, pp. 1392–1402, 2012, doi: 10.1016/j.jacc.2011.11.003.
  • M. Sousa-Uva et al., “2018 ESC/EACTS Guidelines on myocardial revascularization,” Eur. J. Cardio-thoracic Surg., vol. 55, no. 1, pp. 4–90, 2019, doi: 10.1093/ejcts/ezy289.
  • M. Götberg, C. M. Cook, S. Sen, S. Nijjer, J. Escaned, and J. E. Davies, “The Evolving Future of Instantaneous Wave-Free Ratio and Fractional Flow Reserve,” J. Am. Coll. Cardiol., vol. 70, no. 11, pp. 1379–1402, 2017, doi: 10.1016/j.jacc.2017.07.770.
  • A. Tolegenuly, R. Ordiene, A. Mamedov, R. Unikas, and R. Benetis, “Correlation between preoperative coronary artery stenosis severity measured by instantaneous wave-free ratio and intraoperative transit time flow measurement of attached grafts,” Med., vol. 56, no. 12, 2020, doi: 10.3390/medicina56120714.
  • J. Knuuti, “2019 ESC Guidelines for the diagnosis and management of chronic coronary syndromes The Task Force for the diagnosis and management of chronic coronary syndromes of the European Society of Cardiology (ESC),” Russ. J. Cardiol., vol. 25, no. 2, 2020, doi: 10.15829/1560-4071-2020-2-3757.
  • A. Jeremias et al., “Multicenter core laboratory comparison of the instantaneous wave-free ratio and resting Pd/Pawith fractional flow reserve: The RESOLVE study,” J. Am. Coll. Cardiol., vol. 63, no. 13, pp. 1253–1261, 2014, doi: 10.1016/j.jacc.2013.09.060.
  • B. Modi et al., “Revisiting the Optimal FFR and iFR Thresholds for Predicting the Physiological Significance of Coronary Artery Disease,” Circ. Cardiovasc. Interv., vol. 11, no. 12, p. e007041, 2018, doi: 10.1161/CIRCINTERVENTIONS.118.007041.Revisiting.
  • World Health Organization, “DALY estimates, 2000-2016,” no. June, 2018.
  • F. J. Neumann et al., “2018 ESC/EACTS Guidelines on myocardial revascularization,” Eur. Heart J., vol. 40, no. 2, pp. 87–165, 2019, doi: 10.1093/eurheartj/ehy394.
  • L. Rupprecht, C. Schmid, K. Debl, D. Lunz, B. Flörchinger, and A. Keyser, “Impact of coronary angiography early after CABG for suspected postoperative myocardial ischemia,” J. Cardiothorac. Surg., vol. 14, no. 1, pp. 1–7, 2019, doi: 10.1186/s13019-019-0876-0.
  • P. K. Hol et al., “The importance of intraoperative angiographic findings for predicting long-term patency in coronary artery bypass operations,” Ann. Thorac. Surg., vol. 73, no. 3, pp. 813–818, 2002, doi: 10.1016/S0003-4975(01)03459-2.
  • M. Hamon et al., “Diagnostic performance of 16- and 64-section spiral CT for coronary artery bypass graft assessment: Meta-analysis,” Radiology, vol. 247, no. 3, pp. 679–686, Jun. 2008, doi: 10.1148/radiol.2473071132.
  • T. S. Meyer et al., “Improved Noninvasive Assessment of Coronary Artery Bypass Grafts With 64-Slice Computed Tomographic Angiography in an Unselected Patient Population,” J. Am. Coll. Cardiol., vol. 49, no. 9, pp. 946–950, 2007, doi: 10.1016/j.jacc.2006.10.066.
  • F. L. Gobel et al., “Safety of coronary arteriography in clinically stable patients following coronary bypass surgery. Post CABG Clinical Trial Investigators.,” Cathet. Cardiovasc. Diagn., vol. 45, no. 4, pp. 376–81, Dec. 1998.
  • R. Jabara et al., “Comparison of Multidetector 64-Slice Computed Tomographic Angiography to Coronary Angiography to Assess the Patency of Coronary Artery Bypass Grafts,” Am. J. Cardiol., vol. 99, no. 11, pp. 1529–1534, Jun. 2007, doi: 10.1016/j.amjcard.2007.01.026.
  • R. Goetti et al., “Low dose high-pitch spiral acquisition 128-slice dual-source computed tomography for the evaluation of coronary artery bypass graft patency,” Invest. Radiol., vol. 45, no. 6, pp. 324–330, Jun. 2010, doi: 10.1097/RLI.0b013e3181dfa47e.
  • J. Gabriel, S. Klimach, P. Lang, and D. Hildick-Smith, “Should computed tomography angiography supersede invasive coronary angiography for the evaluation of graft patency following coronary artery bypass graft surgery?,” Interact. Cardiovasc. Thorac. Surg., vol. 21, no. 2, pp. 231–239, 2015, doi: 10.1093/icvts/ivv078.
  • K. M. Chinnaiyan et al., “Rationale, design and goals of the HeartFlow assessing diagnostic value of non-invasive FFRCT in Coronary Care (ADVANCE) registry,” J. Cardiovasc. Comput. Tomogr., vol. 11, no. 1, pp. 62–67, 2017, doi: 10.1016/j.jcct.2016.12.002.
  • R. Nakazato et al., “Noninvasive fractional flow reserve derived from computed tomography angiography for coronary lesions of intermediate stenosis severity results from the DeFACTO study,” Circ. Cardiovasc. Imaging, vol. 6, no. 6, pp. 881–889, Nov. 2013, doi: 10.1161/CIRCIMAGING.113.000297.
  • M. Gaudino et al., “Radial-artery or saphenous-vein grafts in coronary-artery bypass surgery,” N. Engl. J. Med., vol. 378, no. 22, pp. 2069–2077, 2018, doi: 10.1056/NEJMoa1716026.
  • D. Collins and S. Goldberg, “Care of the Post-CABG Patient,” Cardiol. Rev., vol. 28, no. 1, pp. 26–35, 2020, doi: 10.1097/CRD.0000000000000261.
  • J. Tatoulis, B. F. Buxton, and J. A. Fuller, “Patencies of 2,127 arterial to coronary conduits over 15 years,” Ann. Thorac. Surg., vol. 77, no. 1, pp. 93–101, 2004, doi: 10.1016/S0003-4975(03)01331-6.
  • S. Goldman et al., “Long-term patency of saphenous vein and left internal mammary artery grafts after coronary artery bypass surgery: Results from a Department of Veterans Affairs Cooperative Study,” J. Am. Coll. Cardiol., vol. 44, no. 11, pp. 2149–2156, 2004, doi: 10.1016/j.jacc.2004.08.064.
  • F. Otsuka, K. Yahagi, K. Sakakura, and R. Virmani, “Why is the mammary artery so special and what protects it from atherosclerosis?,” Ann. Cardiothorac. Surg., vol. 2, no. 4, pp. 519–51926, 2013, doi: 10.3978/j.issn.2225-319X.2013.07.06.
  • A. Zientara et al., “Skeletonized internal thoracic artery harvesting: A low thermal damage electrosurgical device provides improved endothelial layer and tendency to better integrity of the vessel wall compared to conventional electrosurgery,” J. Cardiothorac. Surg., vol. 13, no. 1, pp. 1–8, 2018, doi: 10.1186/s13019-018-0797-3.
  • G. Tinica, R. Chistol, D. Bulgaru Iliescu, and C. Furnica, “Long‑term graft patency after coronary artery bypass grafting: Effects of surgical technique,” Exp. Ther. Med., pp. 359–367, 2018, doi: 10.3892/etm.2018.6929.
  • G. M. Lawrie, J. T. Lie, G. C. Morris, and H. L. Beazley, “Vein graft patency and intimal proliferation after aortocoronary bypass: Early and long-term angiopathologic correlations,” Am. J. Cardiol., vol. 38, no. 7, pp. 856–862, 1976, doi: 10.1016/0002-9149(76)90798-0.
  • E. Chignier and R. Eloy, “Adventitial resection of small artery provokes endothelial loss and intimal hyperplasia,” Surg. Gynecol. Obstet., vol. 163, no. 4, pp. 327–334, 1986.
  • W. R. Brody, J. C. Kosek, and W. W. Angell, “Changes in vein grafts following aorto-coronary bypass induced by pressure and ischemia.,” J. Thorac. Cardiovasc. Surg., vol. 64, no. 6, pp. 847–854, 1972, doi: 10.1016/s0022-5223(19)39813-7.
  • J. K. Mcgeachie, S. Meagher, and F. J. Prendergast, “VEIN‐TO‐ARTERY GRAFTS: THE LONG‐TERM DEVELOPMENT OF NEO‐INTIMAL HYPERPLASIA AND ITS RELATIONSHIP TO VASA VASORUM AND SYMPATHETIC INNERVATION,” Aust. N. Z. J. Surg., vol. 59, no. 1, pp. 59–65, 1989, doi: 10.1111/j.1445-2197.1989.tb01466.x.
  • M. S. Lemson, J. H. M. Tordoir, M. J. A. P. Daemen, and P. J. E. H. M. Kitslaar, “Intimal hyperplasia in vascular grafts,” Eur. J. Vasc. Endovasc. Surg., vol. 19, no. 4, pp. 336–350, 2000, doi: 10.1053/ejvs.1999.1040.
  • E. Allaire and A. W. Clowes, “Endothelial cell injury in cardiovascular surgery: The intimal hyperplastic response,” Annals of Thoracic Surgery, vol. 63, no. 2. pp. 582–591, Feb-1997, doi: 10.1016/S0003-4975(96)01045-4.
  • N. Roubos, F. L. Rosenfeldt, S. M. Richards, R. A. J. Conyers, and B. B. Davis, “Improved preservation of saphenous vein grafts by the use of glyceryl trinitrate-verapamil solution during harvesting,” Circulation, vol. 92, no. 9 SUPPL. 1995, doi: 10.1161/01.cir.92.9.31.
  • T. Z. Lajos, F. Robicsek, M. Thubrikar, and H. Urschel, “Improving patency of coronary conduits ‘valveless’ veins and/or arterial grafts,” J. Card. Surg., vol. 22, no. 2, pp. 170–177, 2007, doi: 10.1111/j.1540-8191.2007.00380.x.
  • T. Wada et al., “Impact of instantaneous wave-free ratio on graft failure after coronary artery bypass graft surgery,” Int. J. Cardiol., vol. 324, no. July 2013, pp. 23–29, 2021, doi: 10.1016/j.ijcard.2020.09.046.
  • M. Götberg et al., “Instantaneous wave-free ratio versus fractional flow reserve to guide PCI,” N. Engl. J. Med., vol. 376, no. 19, pp. 1813–1823, 2017, doi: 10.1056/NEJMoa1616540.
  • J. E. Davies et al., “Use of the instantaneous wave-free ratio or fractional flow reserve in PCI,” N. Engl. J. Med., vol. 376, no. 19, pp. 1824–1834, May 2017, doi: 10.1056/NEJMoa1700445.
  • F. Rey, S. Degrauwe, S. Noble, and J. F. Iglesias, “The dynamic effect of coronary artery bypass grafting on the instantaneous wave-free ratio in the collateral donor artery of a patient with chronic total occlusion,” Eur. J. Cardio-Thoracic Surg., vol. 00, pp. 1–3, 2020, doi: 10.1093/ejcts/ezaa463.