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Collateral flow reserve and right coronary occlusion: evaluation during off-pump revascularization
Jean-Philippe Verhoye1, Bertand de Latour, Agnes Drochon
1Department of Thoracic and Cardiovascular Surgery, University Hospital Centre, Rennes, France. jverhoye@stanford.edu
Insights
In patients with three-vessel disease, collateral flow reserve (FFR(coll)) did not correlate with angiographic collateral grading. Left ventricular ejection fraction better predicts functional collateralization than Rentrop grade.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Cardiac Surgery
Background:
- Three-vessel disease with chronic total occlusion presents complex revascularization challenges.
- Assessing functional significance of coronary collaterals is crucial for treatment decisions.
- Off-pump coronary artery bypass grafting is a surgical approach for complex coronary artery disease.
Purpose of the Study:
- To determine pressure-derived collateral fractional flow reserve (FFR(coll)) in patients with three-vessel disease and chronic right coronary artery occlusion.
- To compare preoperative FFR(coll) with Rentrop grade and left ventricular ejection fraction (LVEF).
- To evaluate the impact of left coronary artery revascularization on FFR(coll).
Main Methods:
- Retrospective analysis of eight patients undergoing off-pump coronary artery bypass grafting.
- Preoperative coronary angiography to assess collaterality (Rentrop grade).
- Measurement of FFR(coll) before (FFR(coll) 0) and after left coronary artery revascularization (FFR(coll) 1).
Main Results:
- No correlation was found between preoperative Rentrop grade and FFR(coll) 0.
- A significant linear correlation was observed between FFR(coll) 0 and LVEF (P<0.001).
- No significant change in FFR(coll) was noted after left coronary artery bypass grafting.
Conclusions:
- Coronary angiogram-derived collaterality (Rentrop grade) is a poor predictor of functional collateral flow.
- Left ventricular ejection fraction is a better indicator of functional collateralization.
- Revascularization of the occluded right coronary artery is justified despite left-sided grafting, as indicated by stable FFR(coll).
Abstract:
The aim of this study was the determination of the pressure-derived collateral fractional flow reserve (FFR(coll)) in patients with three vessel disease and chronic occlusion of the right coronary artery undergoing surgical complete revascularization with the off-pump technique. The angiograms of eight patients were preoperatively analysed to quantify collaterality. FFR(coll) was determined before any revascularization (FFR(coll) 0), and after revascularization of the left coronary arteries, (FFR(coll) 1). FFR(coll) 0 was compared to the Rentrop grade, to the left ventricular ejection fraction (LVEF), and to FFR(coll) 1. No correlation was demonstrated between preoperative Rentrop grade and FFR(coll) 0. There was a linear statistically significant correlation between FFR(coll) 0 and LVEF (P;ie0.001). No significant variation of the FFR(coll) index was observed after performing left coronary artery bypass grafts. Collaterality observed on the coronary angiogram cannot be used as an estimation of the functional collaterality, which can be better appreciated with the LVEF. The absence of variation of FFRcoll before and after left coronary artery revascularization suggests that grafting of the occluded right coronary artery remains justified.
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