JOURNAL OF SHANGHAI JIAOTONG UNIVERSITY (MEDICAL SCIENCE) ›› 2020, Vol. 40 ›› Issue (07): 936-942.doi: 10.3969/j.issn.1674-8115.2020.07.012

• Original article (Clinical research) • Previous Articles     Next Articles

Study of quantitative flow ratio-guided surgical coronary revascularization

ZHU Yun-peng1*, ZHU Jia-xi 1*, ZHANG Wei 2, CHEN An-qing1, WAGN Zhe 1, LIU Jun1, ZHOU Mi 1, YE Xiao-feng1, TU Sheng-xian 3#, ZHAO Qiang1#   

  1. 1. Department of Cardiovascular Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China; 2. Department of Biostatistics, Fudan School of Public Health, Shanghai 200032, China; 3. Med-X Institute, Shanghai Jiao Tong University School of Biomedical Engineering, Shanghai 200240, China
  • Online:2020-07-28 Published:2020-09-23
  • Supported by:
    Clinical Science Innovation Project of Shanghai Shenkang Hospital Development Center ( SHDC12018X11); Shanghai Jiao Tong University “Med-X Foundation” Project (YG2016ZD09); Clinical Research Project of Ruijin Hospital,Shanghai Jiao Tong University School of Medicine (2018CR001).

Abstract: Objective · To analyze the feasibility, safety and preliminary clinical results of quantitative flow ratio (QFR)-guided surgical coronary revascularization. Methods · From Jan 2018 to June 2019 at the Department of Cardiovascular Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, patients undergoing elective cardiac surgery with any coronary stenosis ≥ 50%, evaluated by preoperative coronary angiography visualization, were enrolled consecutively. There were 82 patients with 174 coronary artery vessels. Coronary artery bypass grafting (CABG) was recommended with a QFR value ≤ 0.8. The data of baseline characteristics, surgical procedure and perioperative outcomes were collected and analyzed. Results · QFR analysis was successfully carried out in 82 patients and 174 coronary artery vessels. QFR was detected positive ( ≤ 0.8) in 53 vessels (30.5%) and negative (>0.8) in the remaining 121 vessels (69.5%). As guided with QFR, 39 patients (47.6%) with 62 vessels (35.6%) proceeded to surgery for primary heart disease with concomitant CABG as planned, while the remaining 43 patients (52.4%) with 112 vessels (64.4%) changed revascularization strategy or spared CABG. Fifteen patients with simple coronary artery disease avoided CABG and discharged. Among the remaining 67 patients operated on, there were 2 deaths, 4 hemodialysis for new renal failure, 1 perioperative myocardial infarction and 1 stroke within 30 d. No unplanned revascularization was observed. The composite adverse events occurred in 6 cases (9.0%). Conclusion · QFR-guided surgical coronary revascularization is feasible and safe. This strategy could reduce the unnecessary bypass grafting. Further follow-up and prospective clinical trials are warranted to evaluate the effectiveness.

Key words: cardiac surgery, coronary artery bypass grafting, fractional flow reserve, quantitative flow ratio, perioperative clinical results

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