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Successful Coronary Artery Bypass Grafting Based Solely on Non-Invasive Coronary Computed Tomography Angiography

Hideyuki Kawashima1, Yoshinobu Onuma2, Daniele Andreini3

  • 1Department of Cardiology, National University of Ireland, Galway (NUIG) and CORRIB Corelab and Center for Research and Imaging, Galway, Ireland; Department of Cardiology, Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands.

Cardiovascular Revascularization Medicine : Including Molecular Interventions
|September 24, 2021
PubMed

Insights

Coronary artery bypass grafting (CABG) for three-vessel coronary artery disease was successfully planned using coronary computed tomography angiography (CCTA) and fractional flow reserve derived from CT (FFRCT). Post-CABG FFRCT assessment confirmed the safety and efficacy of this non-invasive approach.

Area of Science:

  • Cardiovascular Imaging
  • Interventional Cardiology
  • Medical Technology

Background:

  • Chronic coronary disease management often involves complex revascularization strategies.
  • Three-vessel coronary artery disease (3VD) typically requires comprehensive assessment for optimal treatment planning.
  • Non-invasive imaging modalities are increasingly utilized to guide cardiovascular interventions.

Observation:

  • An 81-year-old female with Canadian Cardiovascular Society angina grade III underwent coronary computed tomography angiography (CCTA).
  • CCTA revealed three-vessel coronary artery disease (3VD), necessitating surgical intervention.
  • Coronary artery bypass grafting (CABG) was planned and executed based on CCTA and fractional flow reserve derived from computed tomography angiography (FFRCT).

Findings:

  • The CABG procedure involved left internal mammary artery to left anterior descending artery (LAD), saphenous vein graft (SVG) to right coronary artery (RCA), and SVG to obtuse marginal artery (OM).
  • A 30-day follow-up using CCTA and FFRCT demonstrated normalized FFRCT values for RCA and LAD, indicating successful revascularization.
  • A borderline pressure drop (FFRCT=0.79) was noted in the distal obtuse marginal artery (OM), highlighting the utility of FFRCT in assessing graft function.

Implications:

  • This case represents the first reported use of post-CABG FFRCT assessment, showcasing its potential as a novel non-invasive tool.
  • FFRCT can provide functional insights into epicardial conductance vessels after surgical revascularization.
  • Sole reliance on CCTA combined with FFRCT for planning and assessing CABG in 3VD patients demonstrates a safe and effective non-invasive strategy.

Keywords:
Computed tomography angiographyCoronary artery bypass graftingFASTTRACK CABGFractional flow reserve derived from computed tomography angiographySYNTAX Score

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