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Quantitative flow ratio-guided versus angiography-guided operation for valve disease accompanying coronary heart

Wenlong Yan1, Yangyang Wang2, Xin Zheng3

  • 1Department of Cardiovascular Surgery, The Affiliated Hospital of Qingdao University, Qingdao University, Qingdao, China.

Frontiers in Cardiovascular Medicine
|March 20, 2023
PubMed

Insights

A quantitative flow ratio (QFR)-guided strategy for valve replacement plus coronary artery bypass graft (VR+CABG) surgery significantly reduced major adverse cardiac and cerebrovascular events (MACCE) at one year compared to angiography guidance.

Area of Science:

  • Cardiovascular Surgery
  • Interventional Cardiology
  • Medical Imaging and Diagnostics

Background:

  • Valve replacement combined with coronary artery bypass graft (VR+CABG) surgery typically has higher mortality and complication rates.
  • Angiography is the standard method for guiding CABG procedures.
  • There is a need to explore strategies that can improve clinical outcomes in VR+CABG patients.

Purpose of the Study:

  • To evaluate if a quantitative flow ratio (QFR)-guided strategy can enhance clinical outcomes in patients undergoing VR+CABG.
  • To compare the efficacy of QFR-guided revascularization versus traditional angiography-guided revascularization in this patient population.

Main Methods:

  • A retrospective study of 536 patients undergoing VR+CABG between January 2018 and December 2021.
  • Patients were divided into a QFR-guided group (n=116) and an angiography-guided group (n=420).
  • Propensity score matching was used to minimize selection bias, followed by a 1-year assessment of major adverse cardiac and cerebrovascular events (MACCE).

Main Results:

  • The QFR-guided group demonstrated significantly shorter operative times, extracorporeal circulation times, and clamp times.
  • Intraoperative bleeding volume was also significantly less in the QFR-guided group.
  • The 1-year MACCE rate was significantly lower in the QFR-guided group (6.9%) compared to the angiography-guided group (14.7%).

Conclusions:

  • A QFR-guided strategy appears to optimize the surgical procedure for VR+CABG.
  • This strategy is associated with superior clinical outcomes, evidenced by a reduced 1-year MACCE rate compared to angiography guidance.
  • QFR guidance may represent a more effective approach for revascularization in patients undergoing combined VR+CABG.
Abstract

Keywords:
angiographycoronary artery bypassphysiological assessmentquantitative flow ratiovalve replacement

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